Can a 74-year-old male with bacterial sinusitis and seasonal allergies, taking Flonase (fluticasone) for allergies, be given a Medrol Dose Pak (methylprednisolone) concurrently?

From the Guidelines

I would not recommend taking a Medrol Dose Pak (methylprednisolone) alongside Flonase (fluticasone) without consulting your healthcare provider first, as the combination of these medications requires medical supervision, especially for a 74-year-old male with bacterial sinusitis.

Key Considerations

• Medrol Dose Pak is a corticosteroid that reduces inflammation but can potentially mask infection symptoms or interfere with your body's ability to fight the bacterial infection, as noted in studies such as 1.
• For bacterial sinusitis with greenish drainage, antibiotics are typically the appropriate treatment rather than steroids, as they directly target the bacterial infection.
• Flonase is appropriate for managing seasonal allergies, but adding a systemic steroid like methylprednisolone could increase your risk of side effects such as elevated blood pressure, increased blood sugar, and immune suppression, as discussed in 1 and 1.

Treatment Approach

• The most effective medication class for controlling symptoms of allergic rhinitis is intranasal corticosteroids, such as Flonase, as stated in 1.
• For bacterial sinusitis, the primary treatment should be antibiotics, not steroids, to effectively combat the infection.
• Considering the patient's age and potential for other medications or conditions, it's crucial to consult with a healthcare provider to evaluate the specific situation and recommend appropriate treatment for both bacterial sinusitis and seasonal allergies, taking into account the potential interactions and side effects of medications like Medrol Dose Pak and Flonase, as mentioned in 1 and 1.

From the Research

Treatment of Sinusitis with Corticosteroids

• The use of oral corticosteroids, such as Medrol Dose Pak, in combination with antibiotics, may be beneficial for short-term relief of symptoms in acute sinusitis 2, 3.
• Studies have shown that oral corticosteroids can improve symptoms of acute sinusitis, including facial pain and nasal congestion, when used as an adjunctive therapy to antibiotics 2, 3.
• However, the evidence is limited, and there is a significant risk of bias in the studies 2, 3.

Use of Intranasal Corticosteroids

• Intranasal corticosteroids, such as fluticasone (Flonase), may also be effective in relieving symptoms of acute sinusitis, particularly when used in high doses and for a duration of 21 days 4.
• A systematic review and meta-analysis found that intranasal corticosteroids resulted in a significant, small increase in resolution of or improvement in symptoms at days 14 to 21 4.

Combination Therapy

• The use of corticosteroids, such as methylprednisolone, in combination with antibiotics, such as cefazolin, may accelerate the healing process in experimentally induced rhinosinusitis 5.
• However, the effects of corticosteroids and antibiotics did not significantly differ, and the most significant decrease in myeloperoxidase activity was determined in the animals treated with methylprednisolone-cefazolin 5.

Medrol Dose Pak

• A study found that the use of a Medrol Dose Pak was associated with a successful return of normal range of motion in 78% of patients with early postsurgical loss of flexion after primary ACL reconstruction 6.
• However, this study was not directly related to the treatment of sinusitis, and the use of Medrol Dose Pak for this condition is not well established.