Q. I've had a head cold with runny nose for more than a week and now have pressure in my cheekbones. My doctor wouldn't give me antibiotics, but instead wanted me to inhale prescription steroids through my nose and use over-the-counter pain pills. Should I change doctors?

A. Turns out that the majority of sinus infections are viral and don't respond to antibiotics. The highly regarded Cochrane group published a review of antibiotics use for acute maxillary sinusitis, and found that it resulted in only minor improvement in uncomplicated sinus infections.

However, eight out of 10 folks improve without antibiotics within two weeks, so the negative effects of antibiotics, both on the patient and on the population, may override the small benefit gained.

Indeed, on March 10, a randomized study by another respected source, Clinical Evidence, found that in folks with clinically diagnosed acute sinusitis, the only thing likely to help was intra-nasal corticosteroids given for two to three weeks. These may hasten recovery due to their anti-inflammatory properties, and had only minor side effects. Antihistamines and decongestants were of unknown effectiveness, and antibiotics were deemed unlikely to be beneficial.

What are the negatives of antibiotics? If you get an allergic reaction, like a rash, you can never use that antibiotic (or related ones) ever again in the future. This can happen even if you've never had a rash from it before. Another negative is the development of antibiotic resistance by germs.

But flying largely under the radar is a dangerous type of infection linked to antibiotic use, which has been getting worse and more fatal since 2000. A new hypervirulent strain of the spore-forming germ Clostridium difficile, BI/NAP1, has appeared in North America, Japan, Europe and Hawai'i. C difficile can start to grow in the large bowel if beneficial germs that normally grow there are killed by antibiotics. You can have diarrhea for several days or even as long as eight weeks after antibiotic use. Probiotics like yogurt may not correct this.

C diff is seen mainly in folks older than 65 in hospitals or long-term-care facilities, but we're also starting to see it in younger folks in the community. Avoid it by regular hand-washing with soap and water; alcohol-based hand sanitizers may not kill C diff spores.

Fever, high white-cell counts, and low protein levels may reflect dangerous enlargement of the colon. Special antibiotics and even surgical removal of the colon may be needed.

We should avoid using antibiotics whenever possible, especially broad-spectrum ones like Avelox, Levaquin, and second- and third-generation cephalosporins. But even standard antibiotics like amoxicillin can sometimes cause C diff infections.

Your doctor was quite akamai!

Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i-Manoa John A. Burns School of Medicine. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.