What are the treatment options for acute sinusitis symptoms?

From the Guidelines

Treatment options for sinus infection symptoms should prioritize supportive care, including nasal saline irrigation, analgesics, and decongestants, with antibiotics reserved for severe or persistent bacterial infections. The management of viral rhinosinusitis (VRS) is primarily directed toward relief of symptoms, as antibiotics are ineffective for viral illness and do not provide direct symptom relief 1. For mild to moderate sinus infections, start with nasal saline irrigation (using a neti pot or saline spray) to flush out mucus and irritants. Take analgesics like acetaminophen (Tylenol, 500-1000mg every 6 hours) or ibuprofen (Advil, 400-600mg every 6-8 hours) to reduce pain and inflammation. Decongestants such as pseudoephedrine (Sudafed, 30-60mg every 4-6 hours) can help relieve pressure, but shouldn't be used for more than 3 days to avoid rebound congestion.

Some key points to consider when treating sinus infection symptoms include:

• Nasal purulence alone does not indicate a bacterial infection; discolored nasal discharge is a sign of inflammation and is not specific for infection 1
• Topical intranasal steroids may have a role in managing VRS, even though they do not have a Food and Drug Administration (FDA) indication for this purpose 1
• Antibiotics should be prescribed in children with severe, worsening, or persistent acute bacterial sinusitis, with amoxicillin alone or in combination with clavulanate as the first-line antibiotic choice 1
• For bacterial sinus infections, which typically last over 10 days or worsen after initial improvement, antibiotics like amoxicillin (500mg three times daily for 5-10 days) or amoxicillin-clavulanate may be prescribed by a doctor 1

Using a humidifier, applying warm compresses to the face, and staying hydrated can provide additional relief. Most viral sinus infections resolve within 7-10 days with these supportive measures, while bacterial infections typically require antibiotics to clear completely. It's essential to note that the diagnosis and treatment of acute maxillary and ethmoid rhinosinusitis in immunocompetent adults should be based on clinical guidelines, and sinus radiography and limited sinus computed tomography are not recommended for the diagnosis of uncomplicated rhinosinusitis 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.

Treatment options for sinus infection symptoms include azithromycin.

• The recommended dose for adults is 500 mg once daily for 3 days.
• The recommended dose for pediatric patients is 10 mg/kg once daily for 3 days. 2 2

From the Research

Treatment Options for Sinus Infection Symptoms

• Decongestants are effective in reducing nasal congestion, regardless of its cause 3
• Antihistamines are not effective in reducing nasal stuffiness when administered alone, but are often used in combination with decongestants for upper respiratory illnesses 3
• Common decongestants include phenylpropanolamine, pseudoephedrine, and phenylephrine, although their efficacy varies 3
• Pseudoephedrine is an effective decongestant, and when combined with acetaminophen, is effective in relieving symptoms attributed to the paranasal sinuses associated with the common cold 4
• The combination of pseudoephedrine and acetaminophen has been shown to decrease overall sinus symptom assessment and weighted composite assessment of sinus pressure, pain, and congestion 4
• Possible side effects of pseudoephedrine and acetaminophen include nervousness, which occurred in 4% of recipients in one study 4

Decongestant Options

• Topical decongestants provide a faster and more intense decrease in nasal airway resistance, but have a shorter duration and potential for rebound congestion 3
• Oral decongestants do not have the same risk of rebound congestion, but may have a slower onset of action 3
• Slow-release formulations of decongestants allow for a longer dosing interval, especially during the night 3