On This Page. Close When you have a sinus infection, one or more of your sinuses becomes inflamed and fluid builds up, causing congestion and runny nose. Other conditions can cause symptoms similar to a sinus infection, including: Seasonal allergies Colds. Top of Page. Pain relievers: Children younger than 6 months: only give acetaminophen. Children 6 months or older: it is OK to give acetaminophen or ibuprofen. Cough and cold medicines: Children younger than 4 years old: do not use unless a doctor specifically tells you to.
Use of over-the-counter cough and cold medicines in young children can result in serious and potentially life-threatening side effects. To receive email updates about this page, enter your email address: Email Address. What's this? That makes you more vulnerable to antibiotic-resistant infections and undermines the good that antibiotics can do for others. Worrisome symptoms that can warrant immediate antibiotic treatment include a fever over Note that some health care providers recommend CT scans when they suspect sinus infections.
Most people recover from sinus infections caused by colds in about a week, but several self-help steps may bring some relief sooner:. If you are not responding to a course of antibiotics within days, you may have a resistant strain of bacteria. Consult your physician for an examination and possible culture or DNA analysis of your sinuses.
DNA analysis of sinus drainage allows us to identify the most dangerous resistant strains within 24 hours and to provide a complete analysis of all bacteria in your nose within 1 week. Amoxicillin remains the drug of choice for acute, uncomplicated bacterial sinusitis.
Amoxicillin is most effective when given frequently enough to sustain adequate levels in the infected tissue. While often prescribed twice daily, it is even more effective if taken in 3 or 4 divided doses. Amoxicillin is typically prescribed for days at a time.
While it is critical to finish the entire 10 day course of antibiotics when treating strep throat, there is evidence that shorter courses of treatment may be sufficient for most cases of sinusitis.
Amoxicillin is closely related to the parent compound penicillin and should not be prescribed in patients who are penicillin allergic. Azithromycin is an alternative treatment for patients who are allergic to amoxicillin. The principal advantage of the azithromycin is convenience — the recommended treatment for acute sinusitis is mg once daily for only 3 days.
Unlike amoxicillin, the effectiveness of a azithromycin is enhanced by giving a large single dose rather than spreading the doses out. For this reason, a course of azithromycin should be completed in 3 days or less for sinusitis as in a Zithromax Tri-Pak , and should not be spread out over 5 days as in a Zithromax Z-Pak.
Azithromycin induces antibiotic resistance to itself quickly if prescribed in doses that are too low to kill the bacteria. Generic price listed first; brand price listed in parentheses. Information from reference 2. A systematic review found no notable differences in clinical outcomes for patients with acute bacterial rhinosinusitis who were treated with amoxicillin compared with cephalosporins and macrolides.
The recommended length of antibiotic therapy is 10 days, based on the typical duration of therapy used in randomized controlled trials RCTs. Treatment failure occurs when symptoms progress during treatment or do not improve after seven days of therapy.
A nonbacterial cause or an infection with drug-resistant bacteria should be considered. If symptoms do not improve with amoxicillin therapy, or if there is symptom relapse within six weeks, an alternative antibiotic with a broader spectrum is required.
In refractory cases, referral to an otolaryngologist may be needed. Nonsevere symptoms e. Table 4 summarizes adjunctive treatment therapies. Palpitations, transient hypertension, headache, dizziness, tremor, insomnia, gastric irritation; urinary retention may occur in patients with prostatic hypertrophy. Burning, stinging, dryness, and irritation of the nasal mucosa; sneezing; rebound congestion. Epistaxis, pharyngitis, bronchospasm, coughing, nasal irritation; systemic absorption at recommended doses is minimal.
Not approved by the U. Food and Drug Administration for use in patients with sinusitis. Analgesic treatment is often necessary for patients to relieve pain, get adequate rest, and resume normal activities. Selection of analgesics should be based on the severity of pain. Acetaminophen or a nonsteroidal anti-inflammatory drug given alone or in combination with an opioid is appropriate for mild to moderate pain.
A decongestant may be used to reduce mucosal edema and facilitate aeration and drainage during acute episodes. The effect of decongestants in the nasal cavity, however, does not extend to the paranasal sinuses. In a systematic review of seven studies, nasal decongestants were found to be modestly effective for short-term relief of congestion in adults with the common cold.
Antihistamines are often used to relieve symptoms because of their drying effect. However, there are no studies to support their use in the treatment of acute sinusitis.
According to a Cochrane review, antihistamines do not significantly alleviate nasal congestion, rhinorrhea, or sneezing in persons with the common cold. Therefore, antihistamines should not be used for symptomatic relief of acute sinusitis except in patients with a history of allergy. Nasal irrigation with saline may be used to soften viscous secretions and improve mucociliary clearance.
The mechanical cleansing of the nasal cavity with saline has been shown to benefit patients with chronic rhinosinusitis and frequent sinusitis. A Cochrane review found three small trials showing limited benefit for symptom relief with nasal saline irrigation in adults. Guaifenesin, a mucolytic, has been used to thin mucus and improve nasal drainage. However, because it has not been evaluated in clinical trials, guaifenesin is not recommended as an adjunct treatment for rhinosinusitis.
Intranasal corticosteroids reduce inflammation and edema of the nasal mucosa, nasal turbinates, and sinus ostia. There are no controlled trials supporting the use of systemic corticosteroids for the treatment of acute bacterial rhinosinusitis. Intranasal corticosteroids are minimally absorbed and have a low incidence of systemic adverse effects.
Most studies on intranasal corticosteroid use in patients with acute sinusitis are industry sponsored. These studies suggest that intranasal corticosteroids provide additional benefit in symptom improvement when used with antibiotics. A Cochrane review examined four RCTs with 1, patients. If symptoms worsen or fail to improve with treatment, physicians should reevaluate the patient to confirm the diagnosis of acute bacterial rhinosinusitis, exclude other causes of illness, and detect complications.
Ophthalmology referral is warranted for patients with orbital complications. In addition, if symptoms persist or progress after maximal medical therapy, and if computed tomography shows evidence of sinus disease, patients should be referred to an otolaryngologist. Information from references 7 and 9. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Address correspondence to Ann M. Reprints are not available from the authors. Clinical practice guideline: adult sinusitis.
Otolaryngol Head Neck Surg. Antimicrobial treatment guidelines for acute bacterial rhinosinusitis [published correction appears in Otolaryngol Head Neck Surg. Adult rhinosinusitis defined. Clinical evaluation of rhinosinusitis: history and physical examination. Piccirillo JF. Clinical practice.
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