What is the best course of treatment for a 57-year-old female patient with sinus congestion, possible fluid buildup in the ears, and throat pain, who is planning to travel by air and has a dislike for Augmentin (amoxicillin-clavulanate)?

Treatment for Sinus Congestion with Ear Fluid Buildup in a Patient Planning Air Travel

For a 57-year-old female patient with sinus congestion, ear fluid buildup, and throat pain who is planning air travel and dislikes Augmentin, a cephalosporin antibiotic such as cefuroxime-axetil or cefpodoxime-proxetil is the most appropriate treatment option.

Antibiotic Selection

Based on the patient's presentation with sinus congestion, fluid buildup in the ears, and throat pain for three weeks with worsening symptoms, antibiotic therapy is indicated:

• Cephalosporins (cefuroxime-axetil or cefpodoxime-proxetil) are recommended first-line alternatives for patients who cannot take amoxicillin-clavulanate (Augmentin) 1
• These cephalosporins provide appropriate coverage against common pathogens in acute sinusitis including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 2
• A 5-day course of cefuroxime-axetil or cefpodoxime-proxetil has been shown to be effective for acute sinusitis 1
• Macrolides (azithromycin, clarithromycin) are also options for patients with penicillin allergies, though they have higher resistance rates 1, 2

Adjunctive Therapies

In addition to antibiotics, the following supportive measures should be recommended:

• Intranasal corticosteroids to reduce inflammation and improve sinus drainage 1
• Saline nasal irrigation to help clear secretions 1
• Adequate hydration to thin mucus 1
• Analgesics for pain relief as needed 1
• Decongestants (oral or topical) may help relieve symptoms, particularly before air travel 1

Air Travel Considerations

Given the patient's upcoming air travel, special attention should be paid to:

• Starting treatment immediately to allow time for improvement before the flight on the 15th 1
• Recommending the use of decongestants shortly before and during the flight to help prevent barotrauma 1
• Advising the patient to perform the Valsalva maneuver (pinching nose and gently blowing) during ascent and descent to equalize ear pressure 1

Treatment Duration and Follow-up

• A standard 5-10 day course of antibiotics is recommended 1
• The patient should be advised to complete the full course of antibiotics even if symptoms improve 1
• Follow-up should be arranged if symptoms worsen or do not improve within 3-5 days of starting treatment 1

Potential Pitfalls and Caveats

• Watchful waiting without antibiotics is sometimes recommended for uncomplicated acute rhinosinusitis, but given this patient's prolonged symptoms (three weeks), worsening course, and upcoming air travel, antibiotic therapy is warranted 1
• The benefits of antibiotics must be weighed against potential adverse effects; cephalosporins generally have fewer gastrointestinal side effects than amoxicillin-clavulanate 3, 4
• If the patient fails to respond to initial therapy, consider switching to a fluoroquinolone (levofloxacin or moxifloxacin), though these should be reserved for treatment failures or complicated cases 1

Patient Education

• Explain the importance of completing the full course of antibiotics 1
• Advise on comfort measures including adequate rest, hydration, warm facial packs, and sleeping with the head elevated 1
• Instruct the patient to call if symptoms worsen (especially with headache or high fever) or do not improve within 3-5 days of treatment 1
• Discuss the importance of managing symptoms before air travel to prevent complications such as barotrauma 1