From the Guidelines
For a pregnant woman with sinusitis, it is recommended to preserve the use of saline nasal rinses, topical corticosteroid sprays, and pregnancy-safe antibiotics.
Key Considerations
- Topical corticosteroids: Modern nasal corticosteroid sprays such as budesonide, fluticasone, and mometasone are considered safe for use during pregnancy at recommended doses 1.
- Saline nasal rinses: Saline nasal rinses are a suitable maintenance therapy for chronic rhinosinusitis (CRS) during pregnancy 1.
- Pregnancy-safe antibiotics: Penicillin and cephalosporin are the safest classes of antibiotics and can be given when endoscopic evidence of purulence is present 1.
Important Medications to Avoid
- Oral decongestants: Should not be used due to the risk of fetal gastroschisis and hypertension 1.
- Tetracyclines, aminoglycosides, trimethoprim-sulfamethoxazole, and fluoroquinolones: Should not be used during pregnancy due to the risk of harm to the fetus 1.
- First-generation antihistamines: Should be avoided due to their sedative and anticholinergic properties 1.
From the Research
Preservation for Pregnant Women with Sinusitis
To preserve the health of a pregnant woman with sinusitis, several factors should be considered:
- Diagnosis: It is essential to make a differential diagnosis from pregnancy rhinitis, as sinusitis may present with nasal congestion as the only symptom 2, 3.
- Treatment: Sinusitis should be treated aggressively with increased doses of beta-lactam antibiotics and antral irrigation 2, 3.
- Medication: Due to changes in pharmacokinetics during pregnancy, increased dosage of betalactam antibiotics is needed 2.
- Nasal Decongestants: Nasal decongestants can provide temporary relief but should be used with caution and restricted to a few days to avoid rhinitis medicamentosa 2, 3.
- Nasal Corticosteroids: Nasal corticosteroids may be used in pregnancy when indicated for other sorts of rhinitis, but systemic administration should be avoided 2, 3.
- Safe Relief Methods: Nasal saline washings, exercise, and mechanical alar dilators are safe general means to relieve nasal congestion 2, 3.
- Microbial Aetiology: The most common bacterial findings in pregnant patients with acute rhinosinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 4.
- Immunosuppressive Condition: Pregnancy is an immunosuppressive condition that can predispose women to acute rhinosinusitis, and treatment should include immunocorrection 5.