Why Antibiotics Don't Help for Sinusitis-2
An antibiotic cannot kill all pathogenic bacteria. Each of them has a range of bacteria that it can render ineffective. If your sinuses are infected with a kind of bacteria thatís resistive to a particular antibiotic, you will have no benefit from that antibiotic. Therefore, the antibiotic should match the type of bacteria that causes the infection. This may not be happening in many treatments of chronic sinusitis.
Since only a handful of bacteria causes most cases of acute sinusitis, doctors can easily prescribe a broad-spectrum antibiotic (such as amoxicillin) without identifying the bacteria species. This is somewhat necessary because a complete microbial culture lasts for a few days during which time the problem may become worse if left untreated. I regret to say that there are also economic issues. If every patient with nasal complaints were sent to antral puncture test, the health insurance system would have collapsed a decade ago.
However, the microbiology of acute vs. chronic sinusitis may be very different. In addition to the organisms causing acute sinusitis, chronic sinusitis also may be characterized by the presence of some other bacteria, which cannot be killed by the usual antibiotics that are prescribed for acute sinusitis. A different antibiotic would be necessary in such a situation. The only way to determine the correct antibiotic(s) is to identify the pathogens in the sinuses along with their sensitivity to different antibiotics.
For decades obtaining culture specimens from nose or throat was the way to identify the bacterial species and to prescribe the best-fitting antibiotics. However, culture specimens obtained from nasal swabs correlate poorly with sinus pathogens due to contamination of the swab with normal nasal flora. Actually, it is argued that obtaining accurate microbiological culture data to routinely guide treatment choices for sinusitis is neither practical nor feasible. Now, however, thereís a method that gives reliable results in more than 80% of the cases.
Antral puncture is the aspiration of the maxillary sinus following sterilization of the area beneath the inferior turbinate, a small bone in the nose, to minimize the chance of specimen contamination.
After anesthetization of the puncture site, the surgeon uses an instrument called a trochar and canula to make a small hole inside the nose and into the maxillary sinus. Some of the pus is sucked out and sent to the laboratory to identify the species of bacteria thatís causing the infection. After that, a syringe is used to wash the remaining pus out of the sinus. The procedure may be applied to both maxillary sinuses (the ones on the left and right side of the head) to clear the infection in them. This, of course, doesnít yield lasting relief since the underlying cause remains, but it would be a good start for the treatment that would follow the culture test results.
The best available way for obtaining accurate sinus culture data is an antral puncture. However, since it is an invasive procedure, itís not routinely performed. Also, some doctors start from the least inexpensive diagnostic tools (and also treatment options). So, it is common that a patient, who has visited doctors for years to find a cure for chronic sinusitis, has never undergone an antral puncture test. But, an antral puncture may really reduce the number of procedures a lot, and the identification of appropriate antibiotics may even lead to a cure or lasting relief. There are many examples that are published in otolaryngology journals on the benefits of antral puncture. Sometimes, doctors find an infection due to a rare species thatís resistant to most common antibiotics. Sometimes they find out that fungal infection takes place along with a bacterial one, and so on.
So, if you couldnít find a cure for your sinusitis despite many years of medications, tell this to your doctor and discuss with him/her the choice of having an antral puncture culture.
Until now, the resistance of bacteria against antibiotics has appeared a few times in our text. So, perhaps itís time to address this subject.
As we stated before, each antibiotic has a range of bacteria it can kill. However, this statement isnít complete because nowadays an antibiotic may kill some group of bacteria, while it cannot touch another group of exactly the same species. This happens due to the bacteria having developed ways to circumvent the effects of antibiotics.
Yes, since antibiotics and other antimicrobial drugs first became widely used during World War II, they have saved countless lives and blunted serious complications of many feared diseases and infections. The success of antimicrobials against disease-causing microbes is among modern medicine's great achievements. Unfortunately, however, after more than 50 years of widespread use, many antimicrobials are not as effective as they used to be.
Over time bacteria and other microorganisms that cause infections succeeded in developing ways to survive drugs meant to kill or weaken them. Widespread, sometimes more than necessary, and incorrect use of antibiotics is thought to have contributed much to the bacteriaís evolution that enabled them to survive these powerful drugs.
Antimicrobial resistance provides a survival benefit to microbes and makes it harder to eliminate infections from the body. Diseases such as tuberculosis, gonorrhea, malaria and childhood ear infections are now more difficult to treat than they were just a few decades ago. Infections like tonsillitis, sinusitis and ear infections no longer clear up with a shot of penicillin. Drug resistance is an especially difficult problem for hospitals harboring critically ill patients who are less able to fight off infections without the help of antibiotics. According to data from the U.S. Food and Drug Agency about 70% of bacteria that cause infections in hospitals are resistant to at least one of the drugs most commonly used to treat infections, and worst of all, some organisms are resistant to all approved antibiotics and must be treated with experimental and potentially toxic drugs. The FDA also warns us: ďUnless antibiotic resistance problems are detected as they emerge, and actions are taken to contain them, the world could be faced with previously treatable diseases that have again become untreatable, as in the days before antibiotics were developed.Ē So, the situation is serious, and now every citizen of the globe must use antibiotics sensibly.
Unfortunately, however, some patientsí ill-considered practices contribute to the evolution of microbial resistance too. For example, patients sometimes ask their doctors for antibiotics for the common cold, cough or flu, all of which are viral and don't respond to antibiotics. Also, patients who don't take the full dosing regimen of antibiotics prescribed to them can greatly contribute to bacterial resistance.
This is perhaps what explains why chronic sinusitis is so hard to cure. A biofilm is a complex aggregation of microorganisms marked by the excretion of a protective and adhesive matrix. Bacteria in a biofilm form a starch-like barrier to protect themselves. These protected microbes typically resist the effects of antibiotics, which otherwise kill individual bacteria of the same species rapidly. Thus, a biofilm formation by microorganisms on the mucous membrane may allow organisms to overcome the efforts of the immune system and antibiotics to eliminate them. Some specialists in Georgia claim that bacterial biofilms are the primary cause of chronic sinusitis, and they apply a very bold (to me risky) treatment based on the injection of bacteriphages into sinuses.
Jonathan Cryer from the Division of Rhinology, University of Pennsylvania (USA) and his colleagues have proven the existence of bacterial biofilms in chronic sinusitis cases by using electron microscopy, and they published their results in a high-impact report in the Journal of Otorhinolaryngology.
Research is continuing to find treatments for these biofilms. While there have been positive findings about prevention, modern medicine hasnít devised a killer treatment against bacterial biofilms in sinuses yet. Luckily, scientific research has proven that totally natural substances against biofilms are effective. A sinusitis treatment that uses the best combination of these natural remedies is detailed in our e-book Natural Cures for Sinusitis .
OK, this is tragicomic, but itís true. Itís estimated now that one reason for antibioticsí failure in clearing sinus infections is the length of time the medication is taken. That is, the patient stops using the antibiotics before they can eliminate bacterial infection completely.
It is now recognized that a long course of antibiotic medication may be necessary for chronic cases of sinusitis. While acute ones can be cured in about 10 to 14 days of therapy, for chronic sinusitis antibiotics should be used more than three weeks, and this may have to be as long as 12 weeks. Stopping treatment any earlier may only cause the bacteria to adapt and survive that antibiotic. More and more doctors, now, put their patients on 12 weeksí of antibiotic administration.
But, how the side effects of antibiotics will accumulate during such a long course is another issue to contemplate. Such a long course of antibiotics may wreak havoc on general health because it suppresses the immune system, and makes you vulnerable to many diseases. It also destroys the natural microbiologic flora in your bowels. The result may be chronic fatigue or low mood. And, assume that even this long administration of antibiotics provided no cure, how would you feel?
According to our research, this happens about 50% of the time, so, I never recommend my patients to try such a long regimen of antibiotics; and I donít recommend it to you, either.
ďThe main misconception is that chronic sinusitis is a disease that can be managed with antibiotics alone, and if you give enough antibiotics you can cure the disease. We now know that is certainly not the case because it is not antibiotics what can keep you free of sinus diseases.
Have you read our important notice for female patients regarding sinus surgery ?
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