From the Guidelines
Corticosteroid nasal sprays are not contraindicated in bacterial sinusitis and can be beneficial when used alongside appropriate antibiotic therapy. According to the most recent and highest quality study 1, topical intranasal steroids may have a role in managing symptoms of sinusitis, including bacterial sinusitis. The study found that topical nasal steroids relieved facial pain and nasal congestion in patients with rhinitis and acute sinusitis.
Key Points to Consider
- Intranasal corticosteroids such as fluticasone, mometasone, or budesonide can help reduce inflammation in the nasal passages and sinuses, potentially improving drainage and relieving symptoms like congestion and facial pain 1.
- Typical dosing is 1-2 sprays in each nostril once or twice daily, depending on the specific medication.
- These sprays work by decreasing the inflammatory response that causes mucosal swelling, which can help antibiotics penetrate infected areas more effectively.
- However, corticosteroid sprays should not be used as the sole treatment for bacterial sinusitis; they should complement appropriate antibiotic therapy prescribed for the bacterial infection.
- Patients should be advised that nasal steroids may take several days to achieve maximum benefit, and proper technique involves aiming the spray away from the nasal septum to minimize risk of bleeding or perforation.
Evidence-Based Recommendations
- The use of intranasal corticosteroids as an adjunct to antibiotic therapy may be modestly beneficial in the treatment of patients with recurrent acute or chronic sinusitis 1.
- A systematic review found that topical nasal steroids relieved facial pain and nasal congestion in patients with rhinitis and acute sinusitis, even though many patients likely had viral illness 1.
- The magnitude of effect, however, was small, with 66% of patients improving with placebo at 14 to 21 days, rising to 73% with steroid therapy 1.
Clinical Considerations
- The decision to use intranasal corticosteroids in bacterial sinusitis should be based on individual patient needs and preferences.
- Clinicians should consider the potential benefits and risks of intranasal corticosteroids, including the risk of adverse events, which are rare 1.
- Patients should be educated on proper technique and potential benefits and risks of intranasal corticosteroids.
From the Research
Corticosteroid Sprays in Bacterial Sinusitis
- There is no direct evidence to suggest that corticosteroid sprays are contraindicated in bacterial sinusitis 2, 3, 4, 5, 6.
- However, the use of topical corticosteroid sprays may be associated with an increased risk of fungal infections, such as Alternaria species, in immunocompetent individuals 3.
- The treatment of acute bacterial sinusitis typically involves the use of antibiotics, such as amoxicillin/clavulanate, with or without the use of corticosteroid sprays 2, 4, 5.
- The impact of topical corticosteroid sprays on the sinonasal microbiota is not well characterized, but one study found that their use was associated with a distinct microbiota in control subjects, characterized by higher proportional abundances of certain bacteria 6.
Treatment of Bacterial Sinusitis
- The recommended treatment for acute bacterial sinusitis in adults is amoxicillin with clavulanate, which provides only modest benefit 2, 4, 5.
- Alternative treatments, such as azithromycin, may be effective in some cases, but the choice of antibiotic should be based on the severity of the infection and the patient's medical history 5.
- The use of nasal saline irrigation, with or without added budesonide, may help to improve sinonasal symptoms, but its impact on the sinonasal microbiota is not well characterized 6.