When you have a yellowish runny nose and your face feels heavy after a cold, you wonder if it’s sinusitis and think of antibiotics. However, many cases of acute rhinosinusitis are caused by viruses, and in these cases, antibiotics may only leave side effects and resistance burden without significantly changing the course of the disease.
But that doesn’t mean everyone can wait. There are signs that suggest it has progressed bacterially, and in rare cases, there are signs that require immediate medical attention. Below we have summarized the classification criteria and treatment framework.
Summary
- Most cases of acute rhinosinusitis are viral and improve within 1 to 2 weeks.
- Symptoms lasting more than 10 days, double worsening after improvement, high fever and purulent nasal discharge suggest bacterial origin.
- In mild cases, watchful waiting may be an option.
- Once you have started antibiotics, the rule is to stick to the prescribed period without stopping or extending it.
- If it persists for more than 12 weeks, the approach may change to chronic sinusitis.
1. What is sinusitis?
Sinuses are hollow spaces within the bones around the nose that connect to the nasal cavity through narrow passages that drain mucus. If the mucous membrane swells due to a cold or allergy or the passageway is structurally narrow, drainage is blocked and the accumulated secretions become inflamed. This is rhinosinusitis, often shortened to sinusitis.
The main symptoms are nasal congestion, purulent nasal discharge, postnasal drip, facial pain or pressure, and decreased sense of smell. It may also be accompanied by headache, toothache, cough, and mild fever. It is difficult to distinguish between viral and bacterial symptoms based on symptoms alone, and the duration and progress are the key basis for judgment.
2. Criteria for determining when antibiotics are necessary
| Aspect | Implications |
|---|---|
| Symptoms last less than 10 days and are gradually improving | Most likely viral |
| Symptoms persist for more than 10 days without improvement | Consider the possibility of bacterial infection |
| It gets better, then gets worse again on the 5th or 6th day (double worsening) | Symptoms of bacterial secondary infection |
| High fever around 39 degrees + purulent runny nose + facial pain lasting 3-4 days | Severe bacterial presentation |
Viral symptoms usually peak a few days after onset and then gradually improve. If it deviates from this flow and continues for a long time or worsens again, bacterial conversion is suspected.
If the condition is mild to moderate and does not clearly meet the above criteria, initial observation for a few days and control with adjuvant therapy is a reasonable option. This method does not mean to just leave it alone, but to observe it for a set period of time under the premise that if it worsens, medical care will be sought promptly. If you have an underlying disease, are immunocompromised, or have severe symptoms, we take an active approach from the beginning.
3. If you use antibiotics — duration and common mistakes
If it is determined to be bacterial and antibiotics are started, they are usually taken for a certain period of time. Domestic and international guidelines often suggest a range of approximately 5 to 10 days for acute bacterial rhinosinusitis in adults and 10 to 14 days for children, and the actual period is determined by the attending physician depending on the severity, response, and type of antibiotic.
What is problematic is the arbitrary adjustment in two directions. First, if symptoms improve after a few days, the remaining medication is discontinued. Remaining bacteria may proliferate again, causing recurrence or developing resistance. Second, there are cases where the medicine left behind is taken out the next time similar symptoms occur or the period is arbitrarily extended. The causes may be different, and the dosage and period may not match, which actually clouds judgment.
If there is no response after 3 to 5 days of taking the medication or it gets worse, it is better to see a doctor again. A change in antibiotic type or further evaluation may be necessary.
4. Supportive treatment — what actually helps
- Saline nasal irrigation: Helps drain mucus and washes away irritants. A solution of the specified concentration is prepared with boiled and cooled water or sterilized water, and the irrigation device is washed and dried after each use.
- Intranasal steroid spray: Used to reduce mucosal swelling and expand the discharge passage. Continuous use for several days or more is required for the effect to appear.
- Drink enough water and maintain humidity: Helps reduce the viscosity of secretions
- Nasal decongestant spray: Use only for a short period of time. If used continuously for several days, rebound nasal congestion (medication-induced rhinitis) may occur.
- Pain reliever: Used to control facial pain and headaches, but check for overlap with existing medications.
5. When chronic sinusitis or surgery should be considered
If symptoms persist for more than 12 weeks, it is classified as chronic sinusitis and the approach varies. Rather than managing infection in the acute stage, we also evaluate persistent mucosal inflammation, presence of nasal polyps, allergies, structural factors such as nasal septum deviation, and odontogenic causes. Endoscopy and CT are used to check the condition of the drainage passages.
Treatment begins with a sufficient period of medication based on nasal steroids and irrigation. Nevertheless, if symptoms remain and tests reveal structural obstruction or extensive lesions, endoscopic sinus surgery may be discussed. The goal of surgery is to open the blocked drainage passage, and irrigation and medication are often continued afterwards. Since surgery and its results vary depending on the cause and individual condition, the principle is to discuss and decide based on the test results.
6. Signs that require immediate medical attention
Rarely, there is a complication where the inflammation spreads around the eye or into the skull. If you have the following symptoms, you should seek medical attention without delay.
- Swelling and redness around the eyes or on the eyelids
- Blurred vision, double vision, pain during eye movements
- Severe headache that is different from usual
- Persistent high fever or feeling of stiff neck
- Altered consciousness, severe vomiting, persistent confusion
Frequently Asked Questions
Q. Do I need to take antibiotics if I have yellowish runny nose? A. It is difficult to determine bacterial infection based on the color of nasal discharge alone. Even after a viral cold, it is common for the runny nose to become thicker a few days later. It is judged by looking at the duration, whether it gets worse again, and the degree of fever and pain.
Q. Can I perform nasal irrigation every day? A. In the acute phase, it is often performed 1-2 times a day, and some people continue to perform it in chronic management. However, it is important not to use tap water as is, but to maintain equipment hygiene and solution concentration. If you have a middle ear disease or have recently had nose surgery, please check with your doctor about the method and timing.
Q. I heard that sinusitis recurs frequently. Why is that? A. If factors such as narrow discharge passages, allergic inflammation, nasal polyps, smoking, or a dry environment remain, the same situation is likely to repeat. Rather than repeating only acute treatment, it is more helpful to evaluate background factors that cause recurrence.
This article is general health information and is not a substitute for individual medical care. If symptoms persist or worsen, please seek treatment at a medical institution.