What steroid shot, such as dexamethasone (intramuscular steroid), can be given for sinusitis?

Steroid Treatment Options for Sinusitis

For sinusitis, intranasal corticosteroid sprays are the first-line steroid treatment, while systemic corticosteroids like intramuscular dexamethasone should be reserved only for severe cases with marked mucosal edema or nasal polyps when rapid symptom relief is needed. 1, 2

First-Line Treatment: Intranasal Corticosteroids

• Intranasal corticosteroid sprays are the most effective medication for controlling major sinusitis symptoms including nasal congestion, rhinorrhea, and inflammation 1
• These medications work by reducing inflammation, decreasing vascular permeability, and inhibiting inflammatory mediator release, effectively addressing the underlying cause of congestion 1
• Common intranasal corticosteroids include mometasone furoate, fluticasone propionate, budesonide, and triamcinolone acetonide 3, 4
• Intranasal corticosteroids have been shown to have a positive impact on disease-specific and general quality of life in patients with chronic rhinosinusitis 3
• Proper technique is essential - patients should direct sprays away from the nasal septum to minimize local side effects such as irritation and bleeding 2

When to Consider Systemic Steroids (Including IM Dexamethasone)

• Short courses (5-7 days) of systemic corticosteroids may be appropriate for very severe nasal symptoms, particularly in cases with marked mucosal edema or nasal polyps 2
• Intramuscular dexamethasone can be considered when rapid symptom relief is needed in severe cases 5
• For intramuscular administration, dexamethasone sodium phosphate dosage typically ranges from 0.5 mg/day to 9.0 mg/day depending on the specific disease entity being treated 5
• Systemic corticosteroids should not be used routinely for acute post-viral rhinosinusitis due to limited benefits and potential harm 2
• A Cochrane review found that oral corticosteroids as an adjunctive therapy to oral antibiotics are effective for short-term relief of symptoms in acute sinusitis, though data are limited 6

Evidence for Efficacy

• Studies show that adding intranasal corticosteroids to antibiotic therapy provides modestly beneficial effects in the treatment of recurrent acute or chronic sinusitis 1
• A systematic review found that intranasal corticosteroids increased the rate of symptom improvement from 66% to 73% after 15 to 21 days compared to placebo 3
• For chronic rhinosinusitis with nasal polyps, intranasal corticosteroids showed significant improvement in symptoms and polyp score reduction compared to placebo 3
• The effect size for symptom improvement was larger for nasal blockage (moderate-sized benefit) than for rhinorrhea or loss of sense of smell (small benefit) 4

Treatment Duration and Monitoring

• For acute sinusitis, intranasal corticosteroids are typically used for 10-14 days 1
• For chronic sinusitis, longer-term use may be necessary with periodic examination of the nasal septum to ensure there are no mucosal erosions 1
• If symptoms do not improve after 3-4 weeks of appropriate therapy, consider referral to a specialist 1

Adverse Effects and Precautions

• The most common adverse effect of intranasal corticosteroids is epistaxis (nosebleeds), with a significantly higher risk compared to placebo (RR 2.74,95% CI 1.88 to 4.00) 4
• Local irritation may occur but does not appear to be significantly different from placebo 4
• Unlike topical decongestants, intranasal corticosteroids do not cause rhinitis medicamentosa (rebound congestion) and can be used for longer periods 1
• Systemic corticosteroids may cause adverse effects including insomnia, gastrointestinal disturbances, and mood changes 7
• When using intramuscular dexamethasone, monitor for potential systemic side effects, especially in patients with comorbidities 5

Combination Therapy Approach

• The American College of Allergy, Asthma, and Immunology suggests that intranasal corticosteroids should be used in conjunction with saline nasal irrigation for enhanced effectiveness in chronic sinusitis 2
• Antibiotics should be considered only when there is evidence of bacterial infection 2
• Antihistamines should not be routinely used for viral rhinosinusitis as they have side effects and do not effectively relieve symptoms 1