What is the nasal steroid spray of choice for acute sinusitis?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: February 18, 2025View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

From the Guidelines

Nasal Steroid Spray of Choice for Acute Sinusitis

The nasal steroid spray of choice for acute sinusitis is mometasone furoate, administered at a dose of 200-400 mcg twice daily for a duration of 14-21 days 1. Alternatively, fluticasone propionate may be used at a dose of 200 mcg once or twice daily for a similar duration 1. These medications have been shown to:

  • Reduce nasal congestion
  • Improve sinus drainage
  • Alleviate symptoms of acute sinusitis
  • Have potent anti-inflammatory effects

Key benefits of these medications include:

  • Mometasone furoate: potent anti-inflammatory effects, with studies showing significant improvement in symptoms such as headache, facial pain, and congestion 1
  • Fluticasone propionate: effective in reducing symptoms and improving quality of life, with a favorable safety profile 1

It is essential to note that the choice of nasal steroid spray may depend on individual patient factors, such as symptom severity, medical history, and personal preferences. Additionally, patients should be aware of potential side effects and report any concerns to their healthcare provider 1.

From the FDA Drug Label

INDICATIONS AND USAGE Fluticasone Propionate Nasal Spray, USP, is indicated for the management of the nasal symptoms of seasonal and perennial allergic and nonallergic rhinitis in adults and pediatric patients 4 years of age and older. The FDA drug label does not answer the question.

From the Research

Nasal Steroid Spray for Acute Sinusitis

  • The nasal steroid spray of choice for acute sinusitis is mometasone furoate nasal spray (MFNS) 2, 3, 4, 5
  • Studies have shown that MFNS is effective in relieving symptoms of acute sinusitis, either as monotherapy or as adjunctive treatment to antibiotics 2, 3, 4, 5
  • The efficacy of MFNS has been compared to placebo and antibiotic therapy, with results showing that MFNS produces statistically greater improvements in overall symptoms and most individual symptoms 2, 3, 4
  • The effective dose range of MFNS for acute sinusitis is 200-400 microg, twice daily 3, 4, 5
  • MFNS has been shown to be well-tolerated, with a similar incidence of adverse events compared to placebo 2, 3, 4, 5

Comparison to Other Treatments

  • MFNS has been compared to fluticasone propionate aqueous nasal spray, with results showing that MFNS is at least as effective as fluticasone propionate at equivalent doses 6
  • The use of MFNS as monotherapy or as an adjuvant therapy to antibiotics has been supported by current evidence, with modest but clinically important benefits 5

Key Findings

  • MFNS 200 microg, twice daily, has been shown to be effective in reducing symptoms of acute sinusitis 2, 3, 4
  • Higher doses of MFNS (400 microg) have been shown to have a stronger effect on improvement or complete relief of symptoms 5
  • The use of MFNS has been associated with a significant reduction in symptoms of acute sinusitis, with no significant adverse events reported 2, 3, 4, 5

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Effective dose range of mometasone furoate nasal spray in the treatment of acute rhinosinusitis.

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 2002

Research

Intranasal steroids for acute sinusitis.

The Cochrane database of systematic reviews, 2009

Research

Comparison of once daily mometasone furoate (Nasonex) and fluticasone propionate aqueous nasal sprays for the treatment of perennial rhinitis. 194-079 Study Group.

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 1997

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.