Is Celestone (betamethasone) safe for treating sinusitis during the second trimester of pregnancy?

Celestone (Betamethasone) for Sinusitis in Second Trimester: Not Recommended as First-Line

Celestone (betamethasone) should not be used for routine sinusitis treatment during the second trimester of pregnancy; instead, use intranasal corticosteroids (budesonide, fluticasone, or mometasone) combined with penicillin or cephalosporin antibiotics if bacterial infection is present. 1

Treatment Algorithm for Sinusitis in Second Trimester

First-Line Approach: Intranasal Corticosteroids

• All modern intranasal corticosteroids (budesonide, fluticasone, mometasone) are safe and recommended at standard doses throughout pregnancy for managing sinonasal inflammation 1, 2
• These agents have minimal systemic absorption and do not affect maternal cortisol levels or fetal growth 3
• Intranasal steroids are the safest and most effective first-line treatment for rhinitis symptoms during pregnancy 2

Add Antibiotics if Bacterial Sinusitis is Present

• Penicillin and cephalosporins are the safest antibiotic classes and should be given when endoscopic evidence of purulence is present 1, 4
• Azithromycin is also considered safe and effective for sinus infections in pregnancy 4
• Avoid tetracyclines, aminoglycosides, trimethoprim-sulfamethoxazole, and fluoroquinolones due to fetal risks 1

Supportive Measures

• Saline nasal rinses are safe and effective for symptom relief 4
• Adequate hydration and rest 4
• Avoid oral decongestants, especially in the first trimester, due to associations with congenital malformations 5, 2

Why Not Celestone (Systemic Betamethasone)?

Risks Outweigh Benefits for Sinusitis

Oral/systemic corticosteroids like betamethasone carry significant risks that are not justified for routine sinusitis treatment 1:

• Increased risk of cleft lip with or without cleft palate 1
• Increased incidence of preeclampsia 1
• Higher rates of preterm delivery and low birth weight infants 1
• Hyperglycemia and potential to cause/worsen gestational diabetes, requiring diabetes testing before use 1

When Systemic Steroids Might Be Considered

Short bursts of oral corticosteroids may be safe after the first trimester ONLY in severe cases, particularly when:

• Severe chronic rhinosinusitis is causing asthma exacerbation 1
• The condition is refractory to all other treatments
• Consultation with the patient's obstetrician is mandatory 1

The justification for systemic steroids is much stronger in severe asthma (where risks of untreated disease outweigh medication risks) than in sinusitis, where safer alternatives exist 1

Critical Pitfalls to Avoid

• Do not use systemic corticosteroids when intranasal steroids would suffice - the risk-benefit ratio strongly favors topical therapy 1
• First trimester carries the highest teratogenic risk - systemic steroids should be especially avoided during this period 1, 5
• Do not use off-label budesonide irrigations or corticosteroid nasal drops during pregnancy 1
• Screen for gestational diabetes before considering any prolonged corticosteroid course 1