From the Guidelines
Chronic sinusitis treatment should start with daily saline nasal irrigation and intranasal corticosteroid sprays, as recommended by the most recent and highest quality study 1.
Treatment Overview
The treatment of chronic sinusitis typically involves a combination of medications and self-care strategies.
- Daily saline nasal irrigation using a neti pot or squeeze bottle with sterile saline solution to flush out mucus and irritants
- Intranasal corticosteroid sprays like fluticasone (Flonase) or mometasone (Nasonex), applying 1-2 sprays in each nostril daily to reduce inflammation
Medications
For bacterial infections, antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily for 10-14 days) or doxycycline (100 mg twice daily for 10-14 days) may be prescribed, as suggested by 1 and 1.
- Oral decongestants like pseudoephedrine can provide temporary relief but shouldn't be used for more than 3-5 days to avoid rebound congestion
- For allergic components, antihistamines like loratadine or cetirizine can help
Surgical Intervention
In severe cases unresponsive to medication, endoscopic sinus surgery may be necessary to remove blockages and improve drainage, as recommended by 1, 1, and 1.
Lifestyle Modifications
Lifestyle modifications are also important:
- Avoid known allergens
- Quit smoking
- Maintain good hydration
- Use a humidifier in dry environments
- Elevate your head while sleeping These treatments work by reducing inflammation, fighting infection, improving mucus drainage, and addressing underlying causes like allergies or structural issues that contribute to chronic sinusitis.
From the FDA Drug Label
Azithromycin Tablets, USP are indicated for the treatment of patients with mild to moderate infections (pneumonia: see WARNINGS) caused by susceptible strains of the designated microorganisms in the specific conditions listed below Acute bacterial sinusitis due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae.
500 mg QD × 3 days
The treatment for chronic sinusitis is not directly addressed in the provided drug labels. However, acute bacterial sinusitis is mentioned, and the recommended dose for adults is 500 mg once daily for 3 days.
- Key points:
- The drug labels do not provide information on the treatment of chronic sinusitis.
- Azithromycin is indicated for the treatment of acute bacterial sinusitis.
- The recommended dose for acute bacterial sinusitis in adults is 500 mg once daily for 3 days 2.
- Pediatric dosage for acute bacterial sinusitis is 10 mg/kg once daily for 3 days 2.
It is essential to consult a healthcare professional for proper diagnosis and treatment of chronic sinusitis, as the provided information is not directly applicable to this condition.
From the Research
Treatment Options for Chronic Sinusitis
- Saline irrigation has been shown to improve symptom scores compared to no treatment, with a standardized mean difference (SMD) of 1.42 [95% CI, 1.01 to 1.84] 3
- Topical corticosteroid therapy has been found to improve overall symptom scores (SMD, -0.46 [95% CI, -0.65 to -0.27]) and reduce polyp recurrence after surgery (relative risk, 0.59 [95% CI, 0.45 to 0.79]) 3
- Systemic corticosteroids and oral doxycycline have been shown to reduce polyp size compared to placebo for 3 months after treatment (P < .001) 3
- Leukotriene antagonists have been found to improve nasal symptoms compared to placebo in patients with nasal polyps (P < .01) 3
- Macrolide antibiotic for 3 months has been associated with improved quality of life at a single time point (24 weeks after therapy) compared to placebo for patients without polyps (SMD, -0.43 [95% CI, -0.82 to -0.05]) 3
Medical Therapies for Chronic Sinusitis
- Daily high-volume saline irrigation with topical corticosteroid therapy is recommended as a first-line therapy for chronic sinusitis 3
- A short course of systemic corticosteroids (1-3 weeks), short course of doxycycline (3 weeks), or a leukotriene antagonist may be considered in patients with nasal polyps 3
- A prolonged course (3 months) of macrolide antibiotic may be considered for patients without polyps 3
- Intranasal corticosteroids, antihistamines, and allergen immunotherapy continue to be the best treatments for chronic rhinitis 4
- Dupilumab is the first biologic approved for chronic rhinosinusitis with polyps, and other biologics such as omalizumab, mepolizumab, and benralizumab may have a future role in treatment 4
Symptom Relief
- Fluticasone propionate aqueous nasal spray has been shown to provide significant relief of symptoms of sinus pain and pressure compared to placebo over a 14-day treatment period 5
- Nasal corticosteroids may be beneficial in treating chronic sinusitis, and novel corticosteroid delivery devices such as an exhalation delivery system for fluticasone and bioabsorbable sinus implants provide enhanced and localized distribution of corticosteroids 6, 4