What medications promote drainage in acute sinusitis?

From the Guidelines

Medications that promote drainage in acute sinusitis include decongestants, intranasal corticosteroids, and saline nasal irrigation, as supported by the most recent and highest quality study 1.

Medications for Promoting Drainage

• Oral decongestants like pseudoephedrine (Sudafed) at 30-60mg every 4-6 hours can reduce mucosal swelling and improve sinus drainage, but should be used for no more than 3-5 days to avoid rebound congestion.
• Topical decongestants such as oxymetazoline (Afrin) can be used twice daily for up to 3 days.
• Intranasal corticosteroids like fluticasone (Flonase) or mometasone (Nasonex) at 1-2 sprays per nostril daily can reduce inflammation and promote drainage with fewer systemic effects.
• Saline nasal irrigation using a neti pot or squeeze bottle with sterile saline solution can physically flush mucus and irritants from the sinuses.

Rationale for Medication Choice

These medications work by reducing inflammation and swelling of the sinus passages, which helps to restore normal mucus flow and drainage. While antibiotics may be prescribed for bacterial sinusitis, they don't directly promote drainage but rather address the underlying infection. Adequate hydration is also important as it helps thin mucus secretions, making them easier to drain, as noted in 1.

Evidence for Saline Irrigation

A Cochrane review reported minor improvements in nasal symptom scores with the use of nasal saline in both physiologic and hypertonic concentrations, as mentioned in 1. Additionally, a study on saline nasal irrigation or lavage showed greater improvement in nasal airflow and quality of life as well as a better rate of improvement in total symptom score when compared with placebo in patients treated with antibiotics and decongestants, as noted in 1.

Considerations for Treatment

The use of these medications should be based on individual patient needs and medical history, taking into account potential side effects and interactions. It is essential to follow the recommended dosage and duration of treatment to minimize risks and maximize benefits, as emphasized in 1 and 1.

From the FDA Drug Label

Principal Display Panel Compare to Sudafed® Congestion active ingredient Pseudoephedrine Hydrochloride, 30 mg Nasal Decongestant MAXIMUM STRENGTH • SINUS PRESSURE • SINUS CONGESTION 24 TABLETS actual size NON-DROWSY Padagis™ The medication pseudoephedrine can help promote drainage in acute sinusitis by reducing sinus congestion.

• Pseudoephedrine is a nasal decongestant that can help relieve sinus pressure and congestion, making it easier for the sinuses to drain. 2

From the Research

Medications for Promoting Drainage in Acute Sinusitis

• Decongestants such as xylometazoline, phenylephrine, and pseudoephedrine can help promote drainage by reducing nasal congestion 3.
• Saline nasal washes and steam inhalation can also aid in drainage and relieve symptoms of acute sinusitis 3, 4.
• Topical corticosteroids (intra-nasal) may be used to reduce inflammation and promote drainage 3.
• Antibiotics such as amoxicillin, co-amoxiclav, doxycycline, and cephalosporins may be prescribed to treat bacterial infections, but their use should be judicious and based on clinical guidelines 3, 5.
• Acetylcysteine, a mucolytic agent, has been studied as a potential treatment for subacute sinusitis, but its effectiveness is unclear 6.

Supportive Care for Acute Sinusitis

• Saline irrigation, nasal steroids, and antihistamines can help reduce the severity of symptoms and promote drainage 5.
• Decongestants can provide temporary relief from nasal congestion, but their use should be limited to a few days to avoid rebound congestion 5.
• Steam inhalation and warm compresses can help loosen mucus and promote drainage 4.

Important Considerations

• The diagnosis of acute sinusitis is typically clinical, based on symptoms such as nasal congestion, rhinorrhoea, facial pain, and fever 3, 5.
• Complications of acute sinusitis, such as orbital cellulitis and meningitis, are rare but require prompt medical attention 4, 5.
• Referral to an otolaryngologist may be necessary for patients with recurrent or complicated sinusitis 5, 7.