From the Guidelines
Sinusitis treatment should prioritize symptomatic relief with analgesics, saline irrigation, and topical nasal steroids, while avoiding interventions with questionable efficacy, as recommended by the most recent clinical practice guideline 1.
Treatment Approach
The treatment of sinusitis typically involves a combination of medications and self-care measures. For mild cases, start with over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation.
- Nasal saline irrigation using a neti pot or squeeze bottle with sterile saline solution can help flush out mucus and irritants.
- Decongestants such as pseudoephedrine (Sudafed) can provide temporary relief but shouldn't be used for more than 3 days to avoid rebound congestion.
- Intranasal corticosteroids like fluticasone (Flonase) or mometasone (Nasonex) reduce inflammation and can be used daily for up to several weeks.
Antibiotic Use
For bacterial sinusitis, antibiotics such as amoxicillin (500mg three times daily for 5-10 days) or amoxicillin-clavulanate may be prescribed, as suggested by guidelines for children 1 and applicable to adults as well.
- The use of antibiotics should be judicious, considering the potential for resistance and side effects.
- Home remedies include applying warm compresses to the face, staying hydrated, using a humidifier, and avoiding irritants like cigarette smoke.
Surgical Intervention
In cases where medical management fails, surgical intervention may be necessary, particularly for conditions like nasal polyps or anatomic defects obstructing sinus drainage, as outlined in practice parameter updates 1.
- Functional endoscopic sinus surgery can result in significant improvement for patients with chronic sinusitis.
- However, surgical treatment should be considered on a case-by-case basis, taking into account the severity of symptoms and the presence of complicating factors.
Corticosteroid Use
The use of nasal corticosteroids might be helpful in patients with acute and chronic sinusitis, especially when there is marked mucosal edema or nasal polyposis, as suggested by practice parameter updates 1.
- Oral corticosteroids can be considered as an adjunct in treating patients who fail to respond to initial treatment.
- The short-term use of oral corticosteroids is reasonable in specific clinical scenarios, but their use should be carefully considered due to potential side effects.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Sinusitis
- Antibiotics are a common treatment for acute bacterial sinusitis (ABS), with high-dose amoxicillin or amoxicillin-clavulanate being the initial therapy of choice 2
- Alternative antibiotics include cefuroxime, cefpodoxime, or cefdinir, while clarithromycin or azithromycin may be prescribed in cases of serious drug allergy 2
- The optimal duration of antibiotic therapy is unknown, but some recommend treatment until the patient becomes free of symptoms and then for an additional 7 days 2
Non-Antibiotic Treatments
- Decongestants, antihistamines, and topical corticosteroids may be used to alleviate symptoms of acute sinusitis 3
- Saline nasal washes and steam inhalation may also be beneficial in relieving nasal congestion and promoting drainage 3
Diagnosis and Classification
- Acute sinusitis is defined pathologically by transient inflammation of the mucosal lining of the paranasal sinuses lasting less than 4 weeks 3
- Clinical diagnosis is based on symptoms such as nasal congestion, rhinorrhoea, facial pain, and hyposmia, with or without fever 3
- Classification of rhinosinusitis is important for appropriate diagnosis and management, with best practices for clinical diagnoses and management strategies outlined in recent medical literature 4