From the Guidelines
Viral sinusitis treatment primarily focuses on symptom relief while the body fights the infection naturally, and the most effective approach includes a combination of over-the-counter pain relievers, nasal saline irrigation, and rest. The treatment of viral sinusitis is mainly directed towards relieving symptoms, as antibiotics are ineffective against viral infections 1.
Symptomatic Relief
Symptomatic relief can be achieved through the use of:
- Analgesics or antipyretic drugs, such as acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours, to manage pain and reduce inflammation 1
- Nasal saline irrigation using a neti pot or saline spray several times daily to clear mucus and reduce congestion 1
- Decongestants like pseudoephedrine (Sudafed) 30-60mg every 4-6 hours (maximum 240mg daily) for temporary relief, but not for more than 3 days to avoid rebound congestion 1
- Steam inhalation for 10-15 minutes several times daily and adequate hydration (8-10 glasses of water daily) to help thin mucus secretions
Avoiding Unnecessary Antibiotics
It is essential to note that antibiotics are not recommended for treating viral sinusitis, as they are ineffective against viral illnesses and do not provide direct symptom relief 1.
Monitoring for Bacterial Infection
Most viral sinusitis resolves within 7-10 days without antibiotics, but if symptoms persist beyond 10 days, worsen after initial improvement, or include high fever and severe facial pain, it is crucial to consult a healthcare provider, as this may indicate bacterial infection or complications requiring different treatment 1.
From the Research
Viral Sinusitis Treatment
- The treatment of viral sinusitis typically involves supportive care to alleviate symptoms, as most episodes are self-limited and last 7 to 10 days 2.
- Supportive care for rhinosinusitis may include the use of saline irrigation, nasal steroids or antihistamines, and decongestants to help reduce the severity of symptoms 2, 3, 4.
- Intranasal corticosteroids have been shown to provide a small therapeutic benefit in acute sinusitis, with significant benefits for facial pain and congestion 5.
- A systematic review and meta-analysis found that intranasal corticosteroids resulted in a significant increase in resolution of or improvement in symptoms at days 14 to 21, with a greater benefit seen at 21 days 5.
- The use of antibiotics is generally not recommended for viral sinusitis, unless there is evidence of a bacterial infection, such as severe symptoms or worsening of symptoms over time 2, 6.
- Diagnostic testing for acute rhinosinusitis is not always necessary, but point-of-care testing for elevated C-reactive protein may be helpful in distinguishing between bacterial and viral sinusitis 2.
Management of Acute Sinusitis
- The management of acute sinusitis should include an assessment of pain, with analgesic treatment based on the severity of pain 6.
- Clinicians should distinguish presumed acute bacterial rhinosinusitis from acute rhinosinusitis caused by viral upper respiratory infections and noninfectious conditions 6.
- The panel made a recommendation against radiographic imaging for patients who meet diagnostic criteria for acute rhinosinusitis, unless a complication or alternative diagnosis is suspected 6.
Treatment Options
- Symptomatic relief may be prescribed for managing viral rhinosinusitis, including the use of antihistamines, decongestants, and saline nasal washes 3, 4, 6.
- Topical corticosteroids, such as intranasal corticosteroids, may be used to relieve symptoms of acute sinusitis 5.
- Observation without the use of antibiotics is an option for selected adults with uncomplicated acute bacterial rhinosinusitis who have mild illness and assurance of follow-up 6.