An expert panel of physicians representing a variety of organizations, including the Centers for Disease Control and Prevention (CDC), the American College of Physicians and the Society of Academic Medicine, have affirmed what previous experts have concluded: Antibiotics are not effective in the management of sinus infections, but some natural treatments are.

The panel drew up a new set of guidelines for the Infectious Diseases Society of America (IDSA), which were published in the April 2012 edition of the journal Clinical Infectious Diseases. The basic points in the guidelines are as follows:

• Nearly one in seven people is diagnosed with a sinus infection each year.

• Sinus infections are the fifth leading reason for antibiotic prescriptions, yet up to 98 percent of the infections are caused by viruses, which are not affected by antibiotics.

• Overuse of antibiotics has led to the development of drug-resistant superbugs.

• Antibiotics should only be used when symptoms of a sinus infection last for 10 days or more and are not improving; or?when symptoms are severe, including a fever of 102 degrees or higher, nasal discharge and facial pain for three to four days in a row.

• If you do opt for antibiotics, the IDSA recommends a combination of amoxicillin and clavulanate, which overcome antibiotic resistance. Avoid amoxicillin alone as well as azithromycin, clarithromycin and trimethoprim-sulfamethoxazole, due to increasing drug resistance.

• The IDSA strongly recommends you avoid decongestants and antihistamines. The data is quite clear. Whether the sinus infection is bacterial or viral, decongestants and antihistamines are not helpful and may make symptoms worse.

Natural remedies

In addition to the general recommendation of rest and drinking plenty of liquids, the IDSA also noted that saline irrigation, such as neti pots, is effective in treating sinus infections.

A neti pot is a ceramic pot that looks like a cross between a small teapot and Aladdin’s magic lamp. The neti pot originally comes from the Ayurvedic/yoga medical tradition, but has been used worldwide for centuries.

Typically, to use a neti pot or other nasal irrigation device, you mix about 16 ounces (1 pint) of lukewarm water with 1 teaspoon of salt. Pour the mixture into the pot and tilt your head over the sink at about a 45-degree angle. Place the spout of the pot into your top nostril, and gently pour in the saline solution. The fluid will flow through your nasal cavity and out the other nostril. It may also run into your throat. If this occurs, just spit it out. Blow your nose to get rid of any remaining liquid, then refill the neti pot and repeat the process on the other side. Use the pot once daily when symptoms of a sinus infection are present.

I also recommend mucolytics—natural compounds that thin the mucus and help clear particulate matter and microorganisms from the sinuses. Popular over-the-counter natural expectorants and mucolytics include guaifenesin and N-acetylcysteine (NAC). NAC interacts with the protein bonds of mucus to break it down into less-viscous strands, making it useful for sinusitis and bronchitis. The usual dosage for NAC as a mucolytic is 200 mg three times daily.

Other mucolytics include protein-digesting or proteolytic enzymes such as trypsin, chymotrypsin, serratia peptidase and bromelain. These enzymes have also been shown to break down mucus proteins and have some antimicrobial effects. Bromelain is the most widely available. The usual dosage is 250 to 500 mg three times daily between meals.

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