Si­nus in­fec­tion tricky to erad­i­cate

Cape Breton Post - - Advice/Games - Keith Roach Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health newslette

DEAR DR. ROACH: Af­ter years and years of ex­ces­sive nasal con­ges­tion and post­nasal drip that fre­quently af­fected my speech, I was di­ag­nosed with a pseu­domonas in­fec­tion in my si­nuses. I’ve had a bal­loon sin­u­plasty and two rounds of Cipro. My symp­toms briefly im­proved af­ter each treat­ment, but soon re­verted to their prior con­di­tion. My ear, nose and throat doc­tor has ad­vised that I have three op­tions: live with it, get in­tra­venous an­tibi­otics or have surgery. None of these is ap­peal­ing to me. I would like your opin­ion. — P.G.

AN­SWER: Your ENT doc­tor has the ben­e­fit of hav­ing ex­am­ined you, so I’ll com­ment only on the three op­tions (which make per­fect sense to me). I don’t like the idea of leav­ing a chronic in­fec­tion in the si­nuses. Pseu­domonas is a dan­ger­ous bac­terium: It is hard to kill, is re­sis­tant to many an­tibi­otics and can be in­va­sive through the bones of the si­nus. So I would rec­om­mend treat­ment over just liv­ing with it.

Ciprofloxacin is the pre­ferred, if not the only, oral an­tibi­otic ef­fec­tive against pseu­domonas. How­ever, it might not be ef­fec­tive, and it cer­tainly has down­sides, in­clud­ing po­ten­tially ir­re­versible ef­fects on the bones, soft tis­sues and ner­vous sys­tem. The Food and Drug Ad­min­is­tra­tion has rec­om­mended that it be used in si­nus in­fec­tions only when there are no other op­tions. In­tra­venous an­tibi­otics are then a rea­son­able op­tion. This is done via a PICC (pe­riph­er­ally in­serted cen­tral ca­theter), which al­lows peo­ple to get IV an­tibi­otics while stay­ing at home. Un­for­tu­nately, most an­tibi­otics ef­fec­tive against pseu­domonas must be given more than once daily, and the choice of agents should be guided by a cul­ture. Still, I think a course of IV an­tibi­otics would have a good chance of cur­ing the in­fec­tion. How­ever, the in­fec­tion may come back.

Surgery is likely to be ef­fec­tive as well, but it isn’t guar­an­teed, nor does it solve the prob­lem per­ma­nently. Med­i­cal treat­ment is manda­tory af­ter si­nus surgery.

I would look at the IV an­tibi­otics as the less-in­va­sive op­tion, and it would be my rec­om­men­da­tion based on the lim­ited in­for­ma­tion I have for some­one in your sit­u­a­tion. I still would rec­og­nize that surgery may ul­ti­mately be needed to pre­vent re­cur­rences.

DEAR DR. ROACH:Would it be OK to take mon­telukast with an an­ti­his­tamine? — S.H.

AN­SWER: The com­bi­na­tion of an­ti­his­tamines (such as Clar­itin or Zyrtec) and mon­telukast (Sin­gu­lair) is more ef­fec­tive than ei­ther alone and is com­monly pre­scribed.

DEAR DR. ROACH: I was pleased to read in a re­cent col­umn that you con­tinue to rec­om­mend against high sugar in­take. I was, how­ever, dis­ap­pointed that you failed to quote the over­whelm­ing ev­i­dence re­lat­ing high and fre­quent sugar in­take to in­creased den­tal de­cay. Den­tal caries (de­cay) is the “most preva­lent chronic dis­ease in both adults and chil­dren even though it is largely pre­ventable.” (Na­tional In­sti­tute of Den­tal and Cran­io­fa­cial Re­search) Den­tal caries can not only lead to pain and suf­fer­ing, but in its acute forms of sep­sis, even to death.

I feel as pro­fes­sion­als, both med­i­cal and den­tal, we should con­tinue to re­mind con­sumers that the fre­quent in­take of sugar-sweet­ened food and bev­er­ages is bad for our teeth and that we should limit such con­sump­tion — not only to a spe­cific amount, but also limit the fre­quency of in­take in or­der to give the saliva a chance to coun­ter­act the acid­ity cre­ated by the oral bac­te­ria feed­ing off the sug­ars. — Paul War­ren, D.D.S.

DR. ROACH WRITES: I thank Dr. War­ren for writ­ing. I was ad­dress­ing the con­tro­versy of the ef­fect of sugar on med­i­cal risk, such as heart dis­ease. There is no con­tro­versy about the risk of sugar on den­tal health.

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