Sinusitis
Sinusitis is an inflammation of the sinus cavities of the face most often caused by allergies or viral agents. Allergic rhinitis (nasal passage allergies) is very common and is treated with nasal sprays and oral antihistamines (see our chapter on allergic diseases). Upper respiratory viral illnesses (colds and flus) are also common and respond to symptom management (see our chapter on colds and flus).
Acute bacterial sinusitis may result when an allergic condition or viral infection has created an inflamed, congested sinus drainage system that predisposes it to a bacterial infection. While allergies and viral infections typically resolve without problems, a bacterial infection requires antibiotics. If left untreated, it can develop into a more serious bacterial infection.
The symptoms of acute bacterial sinusitis may include a runny nose, congestion, post-nasal drip, fever, facial pressure or pain, pain in the upper teeth and ear pressure. Since some of these symptoms are the same as those found in allergic or viral illnesses, physicians typically treat patients for non-bacterial causes of sinusitis. If the symptoms persist for longer than a week, especially if there is significant facial or dental pain and fever, antibiotics are begun. People with chronic sinus drainage problems and recurrent bacterial sinusitis may begin antibiotics much sooner.
Treatment
We recommend that you first self-treat allergic rhinitis or viral infections with over-the-counter medications. If your symptoms persist or worsen the following week, or if you develop significant facial or dental pain, seek medical attention.
If you are a healthy person with no history of chronic sinusitis, you can self-treat with the standard antibiotic regimens detailed below. Should your symptoms not respond to therapy within 24 to 48 hours or if you have other chronic respiratory illness, such as COPD or emphysema, medical attention with a local MedToGo physician is warranted.
Standard first line, antibiotic regimens used in the treatment of sinusitis are as follows:
- Trimethoprim-Sulfamethoxazole (80 mg/400 mg); 2 tablets twice a day for 14 days
- Clarithromycin 500 mg orally; twice a day for 14 days
- Ketek (telithromycin) 400 mg; take 2 tablets daily for 10 days
- Amoxicillin/clavulanic acid (875/125); 1 tablet twice a day for 14 days
