Ask the Pediatrician | Illness

'Sinusitis' and 'bronchitis' usually don't need antibiotics

Several times a week I see a child whose parent has recently been diagnosed with “bronchitis” or a “sinus infection” and put on antibiotics and the parent is worried that their recently sick child has caught the infection and needs treatment too.

Here’s the deal: most of the time these infections in children and adults are viral despite the fact that many adult medicine practitioners are quick to put people on antibiotics. In general, if you’ve had symptoms less that 8 or 9 days, chances are what you have is viral and antibiotics won’t make you better any faster.

Sinus infections are not the same thing as sinus pressure with headache. In the first week or so of a viral upper respiratory illness you will feel sinus pressure, have headaches and for the first couple of days of the illness you may even have a fever. Many adults jump the gun and head to their doctor or an urgent care and are put on antibiotics unnecessarily. Snot will turn yellow or green even if the infection is viral, so relying on that as a sign of bacterial illness is a mistake.

Bacterial infections don’t happen in the first 8-9 days because it takes a while for the mucus and swelling from the virus to be there long enough for bacteria to invade it and multiply the point that they cause infection of their own. Here’s a way to think about it. Just like a puddle will be clear for a day or two after a rainstorm, the mucus in your sinuses are “clear” of bacteria. Puddles turn murky after a few days due to bacterial growth and if a sinus infection is going to occur, it takes days of mucus followed by days for the bacteria to invade and multiply before there’s enough of an infection to bring about a response from the body leading to the symptoms of bacterial infection. The mucus in the sinuses initially makes them feel full and exerts pressure but this mucus cannot be infected yet because the bacterial load in the sinuses just isn’t large enough that early in the course of illness.

If after 8-9 days you’re still getting worse or if you were feeling better for a few days and then got worse again, it may mean it is time to head to the doctor. Other signs that your infection may be more than a bad viral illness include fever lasting more than 3-4 days or severe cough.

Bronchitis is viral over 80 percent of the time and is hallmarked by cough which can be bad both day and night. Bronchitis lasts for 3-4 weeks typically but if you have a history of smoke exposure or asthma, you may need to be seen before the three-week mark for other treatments.

Since most illnesses are viral and since secondary bacterial infections don’t occur in adults until 10 days or more into the course of it, most adult practitioners would be wise to suggest symptomatic treatment including using a neti pot for sinus symptoms and waiting it out. And that alone may save a lot of parents the worry and hassle of bringing their children in to see me when I can’t do anything to help them get better faster either.

Dr. Molly O'Shea
Dr. Molly O'Shea is a board-certified pediatrician who cares for families in her practice Birmingham Pediatrics + Wellness Center. She will answer your questions on babies, children, adolescents and families and address common concerns.