Does the Sinus Cocktail Work?

One Sunday morning before the church service began my friend, Johnny, the choir director announced, “I need to go tomorrow to get a sinus cocktail. I have to sing on Friday and that will clear me up.”

“Do you know what a sinus cocktail is?” I asked him.

He said, “It’s a shot that clears up my sinuses. My own doctor won’t give me one, but I found a place where you just walk in and it’s done.”

I happen to be one of those doctors who do not give “sinus cocktails.” I first heard about them 30 years ago when I was a resident in Richmond, Virginia, but many people on the Internet claim they started right here in Memphis. My doctor friends in New York and Chicago have never heard of them.

I understand why people are so enamored with the shot. You have a cold, or are terribly congested with pressure in your sinus cavities, and you want quick relief. What could be easier than a shot? Over the years doctors have convinced people that a shot works faster and is more serious medicine than any other form of treatment, and it is even better if it contains an antibiotic.

But here is the sad truth. There remains, as of December 2013, still no cure for the common cold. I know many patients who over the years have asked me for a Z-Pac believing this relatively ineffective antibiotic can cure the common cold. Alas, it cannot. (I do, however, wish I had the trademark on the name Z-Pac; it’s a great marketing brand.)

“Colds” get their name from the notion that the over 200 viruses that cause them prefer cold weather. The truth is these viruses thrive in low humidity. That is why colds are more common in the winter, when outdoor weather is dryer and central heating dries out the air in our homes. Thankfully the body’s immune system relatively quickly fends off these viruses, and within 7–10 days the usual symptoms go away. There are no known effective treatments to kill the virus sooner. A Z-Pac (Azithromycin) is a good choice for a sexually transmitted infection, but will not cure a cold.

“But what if my snot is green or the infection has gone into my sinuses?” None of this matters. Antibiotics only work against bacteria, and virtually 100 percent of these infections are caused by viruses. All any doctor can do is treat the symptoms, and we are not very good at doing that.

Over the years there have been many attempts to convince us that a cure has been discovered. After winning a Nobel Prize in Chemistry, Linus Pauling spent his life trying to convince us that vitamin C is the answer. Unfortunately, no study—and there have been many—has ever shown convincing evidence that vitamin C works. Lately, both zinc and echinacea have been touted as cures. Both at best have minimal effect.

Virtually nothing advertised for colds on TV does any significant good. I would name names if I weren’t worried about being sued.

This leads us to what your grandmother taught you. Mix one teaspoon of salt in a pint of warm water. Squirt it up your nose, or gargle it if you have a sore throat. Acetaminophen (Tylenol) or aspirin type products can help with feeling bad. Antihistamines can help with the runny nose.   And those sinus cocktails? The formula depends on the provider mixing it up, but usually it consists of an antihistamine (such as Benadryl, which is diphenhydramine) and at least one steroid (usually dexamethasone). It might also contain an antibiotic, such as amoxicillin. The antibiotic will do nothing. The antihistamine and steroid may have a short-term benefit of shrinking the mucus in your nose that causes the congestion, but its effect is only temporary relief, not a cure. Plus, you can get the same medicine at the drugstore without having to endure a painful shot.

As is often the case, the best medicine is prevention. Most colds are transmitted by hand-to-hand contact, so wash your hands frequently.

If you get a cold, know that your body will be making antibodies against that virus and you will never have the same infection again. This leaves only 199 other viruses you can get next winter.


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