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Antibiotics shouldn't be the first choice in treating sinusitis
By Dr. Helen Minciotti | Daily Herald Columnist
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Published: 3/16/2009 12:08 AM

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It was a Sunday afternoon, and with a busy school day looming ahead of her, all the teenager could think of was how miserable she felt.

She had been congested for a couple of days and asked her mom to call me for treatment of her severe sinus headache. I don't usually interject my own medical issues into patient conversations, but it just so happened that I was suffering through a bad cold of my own and had woken up that very morning feeling like my left cheek was about to explode.

I shared this information with the mother, not to elicit sympathy (although that's always nice), but to illustrate a point. I sensed that mom felt that antibiotics would solve her daughter's problem, so I explained that I was simply treating myself with over-the-counter decongestants and pain relievers. I wanted mom to know that if I wasn't jumping to start myself on antibiotics, even though I have relatively easy access, I certainly didn't feel her daughter needed to be given a prescription to treat what sounded like an annoying viral upper respiratory infection.

Colds are uncomfortable and make it hard to function, and for better or worse, you can expect the average URI to last from seven to 14 days. If these common viral infections are treated with a course of antibiotics, they resolve in one to two weeks. I think you get my point.

Is there a time when upper respiratory infections do deserve treatment with antibiotics? Yes, under certain circumstances. Sinuses are cavities in the skull - basically, holes in your head - that become inflamed during colds. When this inflammation persists, sinuses can become infected with bacteria. If a cold lasts several weeks and a child shows no signs of improving on his own, he can have a true sinus infection.

Specialists at the Cincinnati Children's Hospital Medical Center report that the three factors that most often predispose a child to bacterial sinusitis include these viral URIs, allergic inflammation and exposure to smoke. The Cincinnati researchers note that X-rays are generally not used to diagnose sinusitis, as it's really a clinical diagnosis, based on a child's presenting signs and symptoms. Major diagnostic criteria are: URI symptoms lasting more than 10 days without improvement, nasal congestion and discharge of any type - color, though parents often worry about the dreaded green "snot," is not considered diagnostic - and a cough which is usually worse at night. Other possible features of sinusitis are a low-grade fever, ear or throat pain, fatigue, bad breath, intermittent facial puffiness and face or tooth pain.

The bugs that cause sinusitis in children tend to be the same organisms that cause ear infections. Treatment, therefore, is generally the same, with the usual first line antibiotic of choice being high-dose amoxicillin for a 10- to 14-day course. Though a child will not be cured after 72 hours of antibiotics, parents should notify the doctor if they see no signs of improvement during this initial treatment period.

Saline rinses help some pediatric patients, while acetaminophen or ibuprofen can take the edge off sinus headaches and facial pain. The use of a cool mist vaporizer or humidifier in the bedroom can also make nighttime a little more comfortable for young sinus sufferers.

• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.