Most sinusitis cases don’t require antibiotics

DEAR DR. ROACH » Every year and a half to two years, someone in our house gets a sinus infection. We are in our mid60s, and it is always a fight with our doctor to get antibiotics to cure it. We go through at least two weeks of misery with nasal sprays, Tylenol, etc., before he finally decides that it is bacterial and prescribes the antibiotics. I understand that the use of antibiotics has gotten out of control, but I believe that antibiotics sometimes are needed. Should we have to fight this hard to feel well when we take antibiotics infrequently? — J.K.L. are needed, but people can be spared the risks of antibiotics (many of which I have recently discussed, including C. difficile diarrheal infections) by just waiting long enough for the symptoms to get better on their own. Symptomatic treatments — such as saline irrigation, steroid nasal sprays, a few days’ worth of decongestants and, yes, Tylenol — can relieve the misery.

Resistance to antibiotics is becoming a critical issue. I have seen patients die of bacterial infections because we have literally no effective antibiotics with which to treat them. For our own patients’ safety and for public health reasons, we physicians need to prescribe less. I hope you understand why your doctor is being extra cautious about prescribing antibiotics.

DEAR DR. ROACH » Can you tell me the benefits and risks of Namzaric? Who should take it? What is it taken for? — C.J.H.

DEAR READER » Namzaric is a brand name of a combination of two medications for Alzheimer’s disease. Memantidine (also sold as Namenda) and donepazil (Aricept) are used separately for people with moderate to severe dementia. Although these medicines do not stop the underlying cause of dementia, they can slow, stop and sometimes reverse dementia symptoms for a period of time. Both memantidine and donepezil are modestly effective: The combination of the two seems to have better results and may be easier to take, as it’s just one pill.

Side effects can include slow heart rate and stomach upset or diarrhea. There are other serious but rare side effects, so this medication should be given only when it is likely to be of benefit. (I usually don’t give these medications to people with only mild memory loss.)

The booklet on Alzheimer’s disease gives a detailed presentation of this common illness. Readers can obtain a copy by writing: Dr. Roach Book No. 903 628 Virginia Dr. Orlando, FL 32803 Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.