Acute Sinusitis and Treatment Strategies
From U.S. Pharmacist - 2008 -
W. Steven Pray, PhD, RPh
Voir également Traitement Sinusite aiguë en 2010
If the patient has bacterial sinusitis, treatment must include an appropriate antibiotic/antibacterial agent to prevent the development of complications and reduce the risk of chronic sinusitis.[2,8] Physicians usually prescribe empirically, based on the most common organisms. They recommend such products as
- amoxicillin/clavulanate (Augmentin °)
- cefaclor (Alfatil °)
- trimethoprim/sulfamethoxazole (Bactrim °),
- clarithromycin (Naxy °)
- cefuroxime (Zinnat °).
- Fluoroquinolones (e.g. Oflocet °, Ciflox °)
The duration of therapy is controversial. Therapies lasting 10 or 14 days are considered the standard, but some studies seem to show success with regimens as short as three days for trimethoprim/sulfamethoxazole. The quinolones (e.g., Levaquin, Cipro) are also used for successful treatment of acute sinusitis. Antibiotics/antibacterial therapy achieves success in only 75%-90% of patients, however.
The balance may require a second-line agent. Occasionally, patients develop chronic sinusitis, which is not as likely to respond to antibiotic/ antibacterial regimens due primarily to damaged mucosa that often require reconstruction. In these cases, the patient should perhaps seek an otorhinolaryngologist.
As many as 80%-90% of those with chronic sinusitis can expect improvement with advanced procedures such as endoscopic sinus surgery.
Prevention of acute sinusitis is difficult, but it may be possible to reduce the risk through the prompt administration of decongestants at the first sign of a viral respiratory infection. This assumes greater importance if the patient has a history of sinusitis.
Decongestants are useful in acute sinusitis.
Oral products (e.g., pseudoephedrine) act systemically, and should be able to reach the congested tissues of the sinuses better than sprays or drops. However, topical nasal vasoconstrictors (e.g., oxymetazoline, phenylephrine) also hasten flow of secretions through the ostia by decongesting the nasal passages. Physicians may prescribe guaifenesin to thin secretions in acute sinusitis. OTC guaifenesin does not carry this indication, however.
Several authors consider steam therapy important in the adjunctive treatment of acute sinusitis through its ability to increase mucociliary clearance.[4,5] It may also decrease facial pain and improve nasal congestion. The most effective methods of achieving optimal airway humidity are with the use of vaporizers (for steam) or humidifiers (for a cool mist). However, physicians also mention interventions such as sipping hot tea or applying a hot, wet towel over the face.
Acute sinusitis is not a condition in which histamine release plays a role.
Therefore, the use of antihistamines in acute sinusitis is without foundation. Further, antihistamines with anticholinergic activity inhibit secretions, which is counterproductive in acute sinusitis.[1,2] The drying effect of antihistamines on mucous membranes may result in the formation of crusts that block the ostia, hampering sinus drainage.
There are several things you can do on your own to help clear the sinus infection while the antibiotic/antibacterial is killing the organisms. One goal is to keep the normal cleaning of the sinuses working by moistening the airways. You can sip hot fluids and drink a good amount of fluids each day--as much as 8-10 eight-ounce glasses of water. You could also breathe in moisture through the use of a vaporizer or humidifier. You may also place moisture directly into the nasal passages using saline nasal drops or sprays such as Ayr, Nasal, or Ocean.
If you are fatigued or sleeping poorly, you may be more prone to a sinus infection. Strive to get the proper amount of sleep, but do not oversleep. When you lie down, the nose becomes even more congested, perhaps increasing the possibility of sinus problems. Therefore, when you sleep, lie on the same side as the nostril that is least congested. This may help open the nasal passages on the congested side.