What is the typical treatment for sinusitis?

From the Guidelines

The typical treatment for sinusitis includes a combination of symptom management and addressing the underlying cause, with antibiotics such as amoxicillin or amoxicillin-clavulanate commonly prescribed for bacterial sinusitis, as recommended by the most recent guidelines 1. For mild cases, over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help reduce pain and inflammation.

• Nasal saline irrigation using a neti pot or squeeze bottle with sterile saline solution can 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 as directed. Some key points to consider in the treatment of sinusitis include:
• The use of antibiotics, which should be based on the likely bacterial pathogens consistent with the clinical history, as outlined in the guidelines 1.
• The importance of staying hydrated, using a humidifier, applying warm compresses to the face, and elevating the head while sleeping to help promote drainage and reduce symptoms.
• The need to seek medical attention immediately if symptoms persist beyond 10 days, worsen after initial improvement, or include high fever, severe pain, or vision changes. It's also important to note that the treatment of sinusitis may involve a combination of these approaches, and that the specific treatment plan will depend on the individual patient's needs and circumstances, as discussed in the guidelines 1. In general, the goal of treatment is to reduce inflammation of the sinus passages, promote drainage, and eliminate any infection, as outlined in the practice parameter update 1.

From the FDA Drug Label

Adult patients may be started on a 200-mcg once-daily regimen (two 50-mcg sprays in each nostril once daily). An alternative 200-mcg/day dosage regimen can be given as 100 mcg twice daily (one 50-mcg spray in each nostril twice daily). Maximum effect may take several days Regular-use patients who have responded may be able to be maintained (after 4 to 7 days) on 100 mcg/day (1 spray in each nostril once daily).

The typical treatment for sinusitis with fluticasone propionate nasal spray is 200 mcg once daily or 100 mcg twice daily. The treatment may take several days to reach its maximum effect, and the dosage can be maintained at 100 mcg/day after 4 to 7 days if the patient has responded to the treatment 2.

From the Research

Typical Sinus Treatment

• The typical treatment for sinusitis depends on the severity and duration of symptoms 3, 4, 5.
• For mild symptoms, symptomatic treatment is sufficient, while severe symptoms or moderate symptoms lasting more than 7 days may require antibacterial treatment 3.
• Antibiotics such as amoxicillin or amoxicillin-clavulanate are commonly used to treat acute bacterial sinusitis 3, 5.
• The duration of antibiotic therapy is typically 10-14 days, but some studies suggest that a shorter course of 5 days may be effective for uncomplicated acute maxillary sinusitis in adults 4.
• Adjunctive treatments such as decongestants and pain medication may be used to relieve symptoms, but their effectiveness is limited 3.
• In cases of chronic sinusitis, treatment aims to control rhinitis and improve ventilation and function of the sinuses, and may include topical corticosteroids, mast cell stabilizers, or antihistamines 6.
• Surgery may be necessary in some cases to improve ventilation and facilitate drainage of the sinuses 6.

Treatment Options

• Amoxicillin or amoxicillin-clavulanate are commonly used antibiotics for treating acute bacterial sinusitis 3, 5.
• Cefuroxime, cefpodoxime, or cefdinir may be used as alternative antibiotics 5.
• Clarithromycin or azithromycin may be prescribed in cases of serious drug allergy 5.
• Acetylcysteine, a mucolytic and antioxidant agent, has been studied as a potential treatment for subacute sinusitis, but its effectiveness is unclear 7.

Diagnosis and Prevention

• Diagnosis of acute sinusitis is based on symptoms such as purulent rhinorrhoea, purulent secretions in the nasal cavity, tooth pain, and worsening of symptoms following initial improvement 3.
• Imaging studies such as CT scans may be necessary to confirm the diagnosis in some cases 5, 6, 7.
• Prevention of sinusitis includes avoiding upper respiratory tract infections and managing underlying conditions such as rhinitis 6.