What should I do next if I still have green phlegm and cough after completing my course of antibiotics?Ear, Nose & Throat
Hello! I've been having a sinus infection and bronchitis for about 2 weeks now. Even after a course of antibiotics, I'm still having coughs with thick green phlegm. What should I do next?
If you have a sinus infection and bronchitis that has not gone away with antibiotics, you can see an ENT Specialist for an assessment and likely a nasoendoscopy (scope through the nose done in the clinic under local anaesthesia). If there is still infected mucous (mucopus) seen in your nose, a sample of the mucopus has to be taken and sent to the lab for analysis (bacterial culture). This is to determine the type of bacteria responsible for your sinus infection and the antibiotics that will be effective against that bacteria.
You should also be washing your nose with a nasal douche (salt water solution e.g. Neilmed or Flosinus) and apply nasal steroid sprays to your nasal cavities (e.g. Nasonex, Avamys or Nasacort). Most sinus infections do clear with a culture-directed antibiotics. If this fails, you may need a CT scan (speial series of X rays) of the sinuses to assess the severity of your blocked sinuses and the structural abnormalities that caused it.
If you have been refractory to medical treatments and have persistent sinus infection or structural abnormalities on the CT scan, you may need to undergo sinus surgery (functional endoscopic sinus surgery or FESS) to unblock the sinuses. This is a minimally invasive surgery done through the nose under general anaesthesia.
If you do not have a fever or shortness of breath, it is likely that your "bronchitis" is due to postnasal drip from the sinus infection causing accumulation of mucous in your throat region, resuling in phelgm and cough. If your ENT Specialist is concerned about a concurrent lung infection that failed to clear despite treatment of your sinusitis, he or she can refer you to a lung specialist.
Hope this helps and all the best!
If you're still coughing with thick green phlegm even after a course of antibiotics, then you definitely should get your nose and sinuses carefully examined by your friendly ENT specialist who can insert a flexible tiny endoscope/camera into your nose to take a look. I would say that this is one of the more common problems that patients come to see me for, with many patients already having been seen by their Respiratory/Chest specialist.
Bronchitis is a chest infection which may be due to a constant drip of infected mucus flowing down from the back of your nose onto your airway and into your lungs. So it is important to find out where the original true source of your infection is arising from, so that we can treat it effectively. Although it may occasionally be helpful to take a culture swab from your nose, we don't often find that it will change the treatment course because the "bugs" grown are those which we know to commonly cause nose and sinus infections. The antibiotics we usually prescribe already cover these "bugs". In addition, as you have already had a course of antibiotics, the culture swab may often not grow any "bug" at all and come back as "negative".
We may have to arrange a CT scan of your sinuses to see if they are hiding a pool of stagnant trapped infected mucus. We may then prescribe a longer course of antibiotics like Augmentin or Klacid which is best used to treat sinus infections. Sea salt alkaline nasal douches and nasal steroid sprays (Nasonex or Avamys) with antihistamine medications (Aerius or Xyzal) will also be prescribed for you to help clear the trapped nasal secretions.
If things still don't improve with your nose and sinuses, then you may need to undergo minimally invasive surgery to unblock the drainage pathways of your sinuses to wash them out thoroughly. This is called Functional Endoscopic Sinus Surgery (FESS) where the surgery is done through the nasal passages under guidance of a special endoscope/camera. This procedure is quite safe and may done as a daycase.
Hope you feel better soon with the right combination of meds, Cherie!
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