What medications help with sinusitis, rhinorrhea (runny nose), and coughing?

From the Guidelines

For sinusitis, runny nose, and coughing, the most effective treatment approach is to use a combination of over-the-counter medications and supportive care, as antibiotics are only necessary in severe or persistent cases, as indicated by studies such as 1 and 1.

Treatment Options

• Decongestants like pseudoephedrine (Sudafed) or phenylephrine can help reduce nasal congestion by shrinking swollen blood vessels in the nasal passages.
• Antihistamines such as loratadine (Claritin), cetirizine (Zyrtec), or diphenhydramine (Benadryl) can help with runny nose, especially if allergies are contributing to symptoms.
• For coughing, dextromethorphan (found in Robitussin DM) works as a cough suppressant, while guaifenesin (Mucinex) acts as an expectorant to thin mucus.
• Nasal saline sprays can help moisturize nasal passages and clear mucus.
• For sinusitis specifically, pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) can reduce sinus pain and inflammation, as recommended by 1 and 1.

Important Considerations

• Most of these medications should be taken as directed on the packaging, typically every 4-6 hours, and should not be used for more than 7-10 days without consulting a healthcare provider.
• If symptoms persist beyond 10 days, worsen, or are accompanied by high fever, medical attention should be sought as antibiotics may be needed for bacterial sinusitis, as advised by 1 and 1.
• The use of antibiotics should be reserved for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving, as recommended by 1 and 1.

From the FDA Drug Label

Acute bacterial sinusitis 500 mg QD × 3 days The recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with acute bacterial sinusitis is 10 mg/kg once daily for 3 days.

Azithromycin can help with sinusitis.

• The recommended dose for adults is 500 mg QD × 3 days.
• The recommended dose for pediatric patients is 10 mg/kg once daily for 3 days. However, runny nose and coughing are not directly addressed in the provided drug label as indications for azithromycin. 2

From the Research

Medicines for Sinusitis, Runny Nose, and Coughing

• Desloratadine and pseudoephedrine combination therapy is a comprehensive treatment for allergic rhinitis and nasal congestion, as it significantly improves mean reflective nasal congestion scores compared to either component as monotherapy 3.
• Decongestants such as phenylpropanolamine and pseudoephedrine are effective in reducing nasal congestion, whereas phenylephrine is subject to first-pass metabolism and is not bioavailable in currently recommended doses 4.
• Oral phenylephrine HCl is not significantly better than placebo at relieving nasal congestion in adults with seasonal allergic rhinitis, and its efficacy is limited 5, 6.
• Treatments with proven effectiveness for cold symptoms in adults include over-the-counter analgesics, zinc, nasal decongestants with or without antihistamines, and ipratropium for cough 7.
• Nasal saline irrigation, intranasal ipratropium, and topical application of ointment containing camphor, menthol, and eucalyptus oils are effective treatments for children with cold symptoms 7.

Decongestants and Antihistamines

• The combination of desloratadine and pseudoephedrine is a convenient and efficacious treatment for allergic rhinitis symptoms, particularly nasal congestion 3.
• Decongestants such as pseudoephedrine are effective in reducing nasal congestion, and can be used in combination with antihistamines for comprehensive treatment of allergic rhinitis 3, 4.
• Antihistamines are not effective in reducing nasal congestion when administered alone, but can be used in combination with decongestants for treatment of allergic rhinitis 4.

Treatment Options

• Patients with sinusitis, runny nose, and coughing may benefit from treatment with desloratadine and pseudoephedrine combination therapy, or other treatments such as nasal decongestants, antihistamines, and ipratropium for cough 3, 7.
• Clinicians should explore alternative treatment options for patients with nasal congestion, considering the limited efficacy of oral phenylephrine 6.