From the Guidelines
Chronic sinusitis should be treated with a combination of saline nasal irrigation and topical intranasal corticosteroids to reduce inflammation and promote drainage, as recommended by the most recent clinical practice guideline 1.
Treatment Approach
The treatment of chronic sinusitis typically involves a combination of medications and self-care strategies to reduce inflammation and promote drainage.
- Daily saline nasal irrigation using a neti pot or squeeze bottle with distilled water can help flush out mucus and irritants.
- Intranasal corticosteroid sprays like fluticasone (Flonase) or mometasone (Nasonex) can be used once or twice daily to reduce inflammation.
Additional Considerations
For acute flare-ups, oral decongestants such as pseudoephedrine can provide temporary relief, but should not be used longer than 3-5 days to avoid rebound congestion 1.
- Antibiotics like amoxicillin-clavulanate (500-875mg twice daily for 10-14 days) may be prescribed if bacterial infection is suspected.
- Lifestyle modifications are important, including avoiding known allergens, using a humidifier, avoiding smoking, and elevating the head while sleeping.
Surgical Options
If symptoms persist despite medical therapy for more than 12 weeks, surgical options like endoscopic sinus surgery may be considered to improve drainage pathways, particularly in cases where anatomic defects or obstructing nasal polyps are present 1.
- These treatments work by reducing inflammation in the sinus passages, promoting proper drainage, and addressing underlying causes like allergies or structural issues that contribute to chronic sinusitis.
From the FDA Drug Label
Acute Bacterial Sinusitis 500 mg QD × 3 days The recommended dose of azithromycin for acute bacterial sinusitis is 500 mg once daily for 3 days 2.
- Key points:
- Pediatric dosage:
- For pediatric patients with acute bacterial sinusitis, the recommended dose of azithromycin for oral suspension is 10 mg/kg once daily for 3 days 2.
From the Research
Treatment Options for Chronic Sinusitis
- Medical therapies, such as saline irrigation and topical corticosteroid therapy, are necessary to optimize patient quality of life and daily functioning, and minimize the risk of acute inflammatory exacerbations 3
- Daily high-volume saline irrigation with topical corticosteroid therapy is recommended as a first-line therapy for chronic sinusitis 3
- A short course of systemic corticosteroids, short course of doxycycline, or a leukotriene antagonist may be considered in patients with nasal polyps 3
- A prolonged course of macrolide antibiotic may be considered for patients without polyps 3
Role of Corticosteroids in Treatment
- Long-term treatment with corticosteroid nasal spray reduces inflammation and nasal polyp size, and improves nasal symptoms such as nasal blockage, rhinorrea, and the loss of smell 4
- Corticosteroid intranasal drops may be used when intranasal spray fails to demonstrate efficacy 4
- Short courses of oral steroids are recommended in severe chronic rhinosinusitis with nasal polyps or when a rapid symptomatic improvement is needed 4
Postoperative Care
- Prophylactic antibiotics after endoscopic sinus surgery for chronic rhinosinusitis may not be necessary, as they do not improve outcomes and increase the rate of diarrhea 5
- Intranasal corticosteroids should be continued postoperatively to reduce inflammation and improve nasal symptoms 4
Treatment of Acute Sinusitis
- Fluticasone nasal spray as an adjunct to amoxicillin may be effective in reducing the severity of symptoms of sinusitis in children 6
- Recognition and differentiation of acute and chronic sinusitis is important for appropriate and timely diagnoses, and to provide patients with better counseling and care 7