What treatment is recommended for a patient with allergy symptoms, nasal congestion, and a suspected dental infection with a black and tender left upper tooth, currently taking Atarax (hydroxyzine)?

From the Guidelines

The patient should seek immediate dental care for the black, tender upper left tooth and consider adding a nasal corticosteroid spray like fluticasine to their current treatment with hydroxyzine (Atarax) for allergy symptoms. The dental infection, likely indicating a severe infection requiring antibiotics (such as amoxicillin 500mg three times daily for 7-10 days, or clindamycin 300mg four times daily if penicillin-allergic) and possible root canal treatment or extraction, should be prioritized as it can worsen and potentially spread to surrounding tissues if left untreated 1. The black appearance of the tooth suggests necrosis of the dental pulp, indicating advanced infection.

For the allergy symptoms and nasal congestion, continuing hydroxyzine (Atarax) as prescribed is reasonable, but adding a nasal corticosteroid spray like fluticasone (2 sprays per nostril once daily) would help reduce inflammation and congestion, as supported by the most recent and highest quality evidence 1. A saline nasal rinse twice daily can also provide symptomatic relief. It's crucial to address the dental infection promptly to prevent more serious complications like abscess formation or systemic infection, while managing the allergies will improve comfort.

Key considerations include:

• The patient's symptoms of allergy and nasal congestion can be managed with a combination of hydroxyzine and a nasal corticosteroid spray.
• The dental infection requires immediate attention due to the risk of complications.
• Antibiotic therapy for the dental infection should be chosen based on the most likely causative pathogens and local resistance patterns.
• Patient education on the importance of completing the full course of antibiotic therapy and follow-up care is essential.

From the Research

Treatment for Allergy Symptoms and Nasal Congestion

• The patient is already taking Atarax (hydroxyzine) for allergy symptoms, but is requesting a nose spray for additional relief 2, 3.
• Fluticasone furoate nasal spray is a topical corticosteroid that has been shown to be effective in treating allergic rhinitis, particularly when nasal congestion is a major component of symptoms 2.
• Azelastine nasal spray is another option that has been compared to fluticasone in the treatment of allergic rhinitis, with comparable efficacy in symptom control 3.
• Fexofenadine has also been shown to reduce nasal congestion in perennial allergic rhinitis, and may be considered as an additional treatment option 4.

Treatment for Suspected Dental Infection

• The patient has a suspected dental infection with a black and tender left upper tooth, and is requesting an antibiotic 5.
• Penicillin G or penicillin V are currently the antibiotics of choice for treatment of dental infections of usual etiology 5.
• However, it is important to note that antibiotics should only be prescribed when there is a clear indication of a bacterial infection, and that the patient's symptoms and medical history should be carefully evaluated before prescribing an antibiotic 5.
• The patient's dentist or a medical professional should be consulted to determine the best course of treatment for the suspected dental infection.

Additional Considerations

• The patient's use of Atarax (hydroxyzine) and any potential interactions with other medications should be carefully monitored 5, 2, 3.
• The patient's symptoms and response to treatment should be closely monitored, and adjustments to the treatment plan should be made as needed 5, 2, 3.