What is the recommended treatment regimen for a 55-year-old mother with a chronic cough and sneezing, purulent discharge, and a history of dust allergy, who has undergone cholecystectomy (surgical removal of the gallbladder)?

From the Guidelines

For a 55-year-old mother with secretive cough, sneezing, purulent discharge, and a history of dust allergies causing chronic cough, I recommend a treatment approach that prioritizes avoidance of the causal allergen and use of inhaled corticosteroids as the first-line treatment. Given her history of dust allergies, it is crucial to identify and avoid the causal allergen, as recommended by 1. The first-line treatment should include inhaled corticosteroids, such as fluticasone propionate, to reduce airway inflammation, as suggested by 1.

Some key considerations for her treatment regimen include:

• Avoiding exposure to dust and other allergens to prevent exacerbation of symptoms
• Using inhaled corticosteroids, such as fluticasone propionate, as the first-line treatment
• Considering a short course of oral corticosteroids, such as prednisone, if symptoms are severe, as recommended by 1
• Adding a second-generation antihistamine, such as cetirizine or loratadine, to control allergic symptoms
• Using a mucolytic agent, such as N-acetylcysteine, to thin secretions and facilitate expectoration
• Implementing environmental control measures, such as using HEPA air purifiers and removing carpets, to reduce exposure to allergens

It is also important to note that her history of gallbladder removal is not directly relevant to her respiratory symptoms, but it may indicate that she can tolerate medications well. However, it is essential to monitor her for any potential side effects of the medications. As recommended by 1, considering a high-dose inhaled corticosteroid, plus a long-acting inhaled beta agonist, and omalizumab (Xolair) for patients who have allergies, may also be beneficial in her treatment.

From the FDA Drug Label

These trials evaluated the total nasal symptom scores (TNSS) that included rhinorrhea, nasal obstruction, sneezing, and nasal itching in known allergic patients who were treated for 2 to 24 weeks. Patients should use Fluticasone Propionate Nasal Spray, USP, at regular intervals for optimal effect Adult patients may be started on a 200-mcg once-daily regimen (two 50-mcg sprays in each nostril once daily). An alternative 200-mcg/day dosage regimen can be given as 100 mcg twice daily (one 50-mcg spray in each nostril twice daily).

The patient is a 55-year-old mother with a history of allergic reactions to dust, and symptoms of secretive cough and sneezing with pus. Fluticasone Propionate Nasal Spray, USP can be used to treat her symptoms.

• The recommended dosage for an adult patient is 200 mcg once daily (two 50-mcg sprays in each nostril once daily) or 100 mcg twice daily (one 50-mcg spray in each nostril twice daily) 2.
• It is essential to monitor the patient's symptoms and adjust the dosage as needed to minimize systemic effects.
• The patient's history of surgical removal of the gall bladder is not directly relevant to the treatment of her allergic symptoms.
• The patient should be advised to use the medication at regular intervals for optimal effect and to follow up with her healthcare provider to assess the effectiveness of the treatment and make any necessary adjustments 2.

From the Research

Allergic Rhinitis Treatment

The patient's symptoms of secretive cough and sneezing, pus, and allergy to dust are consistent with allergic rhinitis 3. The treatment for allergic rhinitis typically includes:

• Avoiding inciting allergens
• Second-generation H1 antihistamines (e.g., cetirizine, fexofenadine, desloratadine, loratadine)
• Intranasal antihistamines (e.g., azelastine, olopatadine)
• Intranasal corticosteroids (e.g., fluticasone, triamcinolone, budesonide, mometasone)

Antibiotic Treatment

The patient's symptoms of pus and cough may also indicate a bacterial infection. Azithromycin, a macrolide antibiotic, has been shown to be effective in treating various bacterial infections, including respiratory infections 4. Additionally, azithromycin has immunomodulatory effects and can be used to treat chronic inflammatory disorders.

Combination Therapy

The use of azithromycin in combination with other medications, such as acetylcysteine, has been studied in the treatment of chronic otitis media with effusion 5. This combination may also be beneficial in treating the patient's symptoms.

Viral Infections

Azithromycin has also been investigated as a potential treatment for viral infections, including coronaviruses 6. However, more research is needed to determine its effectiveness in treating viral infections.

Treatment Regimen

Based on the patient's symptoms and medical history, a possible treatment regimen could include:

• Second-generation H1 antihistamines or intranasal antihistamines to alleviate allergic rhinitis symptoms
• Azithromycin to treat potential bacterial infections and reduce inflammation
• Avoiding inciting allergens, such as dust, to prevent exacerbation of symptoms
• Monitoring the patient's condition and adjusting the treatment regimen as needed.