What is the treatment for maxillary sinus pain, unilateral facial pain, and dry cough following viral respiratory symptoms?

From the Guidelines

Maxillary sinus pain, unilateral facial pain, and dry cough following viral respiratory symptoms are typically treated with symptomatic relief and watchful waiting, rather than immediate antibiotics.

Treatment Approach

• The treatment approach for these symptoms is largely based on the severity and duration of the symptoms, as well as the presence of any underlying conditions that may be contributing to the symptoms 1.
• Intranasal corticosteroids may be prescribed to help reduce inflammation and alleviate symptoms, and are recommended by several guidelines, including the EP3OS and CPG:AS guidelines 1.
• Antibiotics should be reserved for severe cases, such as those with high fever, facial pain, or swelling, and should not be prescribed for mild cases or for viral infections 1.
• Symptomatic relief measures, such as analgesics and antipyretics, may be offered to help manage pain and fever, and saline nasal irrigation may also be recommended to help alleviate symptoms 1.

Key Considerations

• The overuse of antibiotics for viral respiratory infections is a significant concern, and can contribute to the development of antibiotic resistance and other adverse effects 1.
• Watchful waiting is often recommended for patients with uncomplicated acute rhinosinusitis, as most cases will resolve on their own without the need for antibiotics 1.
• Patients who are seriously ill, or who deteriorate clinically despite initial treatment, should be referred to a specialist for further evaluation and management 1.

From the Research

Treatment for Maxillary Sinus Pain, Unilateral Facial Pain, and Dry Cough

The treatment for maxillary sinus pain, unilateral facial pain, and dry cough following viral respiratory symptoms can be approached in the following ways:

• For patients with mild symptoms, symptomatic treatment and reassurance is the preferred initial management strategy 2, 3.
• Antibiotic therapy should be reserved for patients with moderately severe symptoms who meet the criteria for the clinical diagnosis of acute bacterial rhinosinusitis and for those with severe rhinosinusitis symptoms, especially those with unilateral facial pain, regardless of duration of illness 2, 3.
• The most narrow-spectrum agent active against the likely pathogens, Streptococcus pneumoniae and Haemophilus influenzae, should be used for initial treatment 2, 3.
• Watchful waiting within the first seven to 10 days after upper respiratory symptoms first appear is supported by current guidelines 4.
• First-line antibiotics include amoxicillin with or without clavulanate 4.
• Analgesics, intranasal corticosteroids, and saline nasal irrigation may be used to treat symptoms within the first 10 days of upper respiratory infection, although evidence on their use is poor 4.
• For patients who do not respond to treatment, computed tomography of the sinuses without contrast media is helpful to evaluate for possible complications or anatomic abnormalities 4.

Specific Treatment Options

• Penicillin V is still the first antibiotic drug of choice for treating maxillary sinusitis, due to its effectiveness in vitro and in vivo 5.
• In therapeutic failure, aeration of the maxillary sinus is first recommended, followed by the use of alternative antibiotics such as cefaclor, tetracyclines, or trimethoprim 5.
• Antral puncture and lavage can be used to restore the normal milieu within the sinus 5.