Medications

Reduce inflammation

Blood cells and lining cells of the mucosa in the sinuses can normally fight off foreign invaders. However, when overwhelmed by viruses and bacteria, coupled with a depressed immune system or over-reactivity to allergens, the result is the inflammation associated with sinusitis. With appropriate therapy, a short-lived infection can be treated effectively. Because foreign substances trigger numerous reactions, many treatments are available that can treat the symptoms of inflammation.

Decongestants help reduce airway obstruction and are important in the initial treatment to alleviate symptoms.

• OTC nasal sprays [pseudophedrine (Afrin), phenylephrine (Neo-Synephrine), naphazoline (Naphcon) chlorzoxazone (Forte), Otrivin, for example) work the fastest—within one to three minutes. These agents should not be used for more than three days because they become less effective and more frequent applications become necessary to attain the same clarity in breathing. This "rebound" phenomenon can be reduced by alternating between nostrils and using the medicine less frequently. Some people over-treat their nasal congestion with nasal spray and become dependent on it in order to breathe more easily (a disorder called Rhinitis Medicamentosum). Overcoming the dependency requires a difficult withdrawal program involving oral decongestants, saline, steroid nasal sprays, systemic steroids, or a combination thereof.

• OTC oral decongestants (in tablet or liquid form) contain the active ingredients pseudoephedrine or phenylephrine. Most drug stores offer a wide variety of oral decongestants, all offering similar results. Brand name medications are more expensive but release the drug more slowly, so they can be taken less frequently. Generic medications are less expensive and are taken every four to six hours or as needed. They work much slower than nasal sprays do. Usually, oral decongestants achieve their effect within 30-60 minutes. As with the nasal preparations, oral decongestants may become less effective with prolonged use. The rebound phenomenon exists but is not as severe as with spray preparations. Preparations containing pseudoephedrine are now kept behind the counter at the pharmacy but are still available without a prescription.

• Both nasal and oral decongestants have side effects, including general stimulation causing increased heart rate and blood pressure, insomnia, nervousness, anxiety, tremor, dry mouth, blurry vision, and headache. They may also cause an inability to urinate. Therefore, persons with a history of cardiac disease, high blood pressure, anxiety, or urinary problems (especially prostate disorders) should consult a physician before using decongestants. In addition, combining decongestants with other over-the-counter or prescribed medicines with similar side effects may cause dangerous complications.

Eliminate infection

The chief goal of treatment is wiping out bacteria from the sinus cavaties with antibiotics. This helps to prevent complications, relieve symptoms, and reduce the risk of chronic sinusitis.

• For acute, uncomplicated cases, a synthetic penicillin is used—most commonly amoxicillin (such as Amoxil, Polymox, or Trimox). This antibiotic is effective against the usual microorganisms and is relatively inexpensive. Amoxicillin's main side effects include allergic reactions (throat swelling, hives) and stomach upset.

• People allergic to penicillin can take a sulfur-containing antibiotic called trimethoprim/sulfamethoxazole or TMP/SMX (such as Bactrim, Cotrim, or Septra). This drug is not recommended for people who are allergic to sulfur.

• People who have several episodes of partially treated acute sinusitis or those who have chronic sinusitis may become resistant to amoxicillin and TMP/SMX. Newer synthetic penicillins and cephalosporins such as Augmentin, cefuroxime (Ceftin), and loracarbef (Lorabid) can clear most of the resistant organisms that cause sinus infection.

• Overuse of these "broader-spectrum" antibiotics may eventually lead to organisms evolving that can resist even the most potent antibiotics currently available. Therefore, simpler antibiotics such as amoxicillin should be used first and taken for the entire duration (14-21 days). The basic rule of thumb is to take the antibiotic until the symptoms disappear, and then continue to take the antibiotic for one more week.

Promote drainage

Home remedies that open and hydrate the sinuses may promote drainage. See Self-Care at Home for information on increasing daily fluid intake, inhaling steam, and taking expectorants and pain relievers.

If environmental allergies cause the sinusitis, an antihistamine may help reduce swelling of the mucous membranes. Allergens stimulate white blood cells in the blood and tissues to release histamine into the circulation. This causes fluid to leak from blood vessels into the tissues of the nasal passageways, leading to nasal congestion symptoms.

• Some of the older sedating OTC antihistamines are no longer recommended because they tend to dry out and thicken the mucus, making drainage more difficult.

• Non-sedating antihistamines such as fexofenadine (Allegra), loratadine (Claritin), or desloratadine (Clarinex) do not seem to dry out the mucosa. If nasal congestion is severe, a decongestant can be added (for example, Allegra-D or Claritin-D).

Maintain open sinuses

To treat acute sinusitis, one or more OTC or prescription therapies may be all that is necessary. For those with recurrent bouts of acute sinusitis or chronic sinusitis, the addition of an intranasal steroid may reduce symptoms. Commonly prescribed medications are beclomethasone (Beconase), fluticasone (Flonase), triamcinolone (Nasacort), flunisolide (Nasalide), and Vancenase.

• Steroids are potent inhibitors of inflammation.

• Intranasal steroids (nasal sprays) work directly on the lining of the nasal passages and sinuses with little effect on the rest of the body when taken in prescribed dosages.

• As with the other classes of drugs, many intranasal steroids are available. Some are more tolerable than others. These are prescription medications. These drugs do not relieve symptoms immediately like nasal and oral decongestants do, but once therapeutic drug levels are achieved, symptoms usually improve, and decongestants may be unnecessary.

• During months when environmental allergens are most widespread, the early administration of intranasal steroids may help to prevent sinusitis and keep the sinuses open and draining.