Rhinosinusitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]
Overview
Supportive therapy is the mainstay of treatment for cases of both acute and chronic rhinosinusitis. Antibiotics can be added in select cases of both types of rhinosinusitis.
Medical Therapy
Supportive Therapy
Supportive therapy for symptomatic relief is the mainstay of treatment in both cases of acute and chronic rhinosinusitis. Therapeutic approaches include:[1][2]
- Analgesics and antipyretics, to manage the fever and facial pain associated with rhinosinusitis
- Saline irrigation, which helps relieve nasal obstruction
- Intranasal corticosteroids, which proved to be beneficial in both acute and chronic rhinosinusitis
- Topical corticosteroids
- Oral glucocorticoids can be given for a short period in cases of chronic rhinosinusitis with polyps [3]
Antibiotics
In addition to symptomatic relief, antibiotics can be added in the case of acute bacterial rhinosinusitis if no improvement is observed within 10 days of supportive treatment, if symptoms worsen after initial improvement, or if symptoms are severe at initial presentation.[1][2] First line Antibiotics for acute bacterial rhinosinusitis is amoxicillin alone or in combination with clavulanate. In case of resistance or allergy, second line treatment including trimethoprim-sulfamethoxazole, doxycycline and fluoroquinolones are prescribed for preferably less than 10 days. Different antibiotics and administration routes exist for treatment of chronic rhinosinusitis:
- Oral macrolides: This group of antibiotics are used for treatment of chronic rhinosinusitis with polyps and have antibacterial and anti-inflammatory effects. They inhibit the cytokine release such as IL8, pro-inflammatory transcription factors such as NF-Kβ and impair the neutrophil function (i.e. migration, adhesion and oxidative response).
- Intravenous (IV) antibiotics: Due to high incidence of adverse effects subsequent to IV antibiotics, thus it is only is indicated only in a few conditions:
- Extranasal complications of chronic rhinosinusitis
- Resistance to oral antibiotics
- Allergy or intolerance to oral antibiotics
- Topical antibiotics: Direct delivery to the nasal mucosa, increased local absorption and efficacy. The disadvantages are local adverse effects, dependence to the delivery technique and unknown long-term effects.
Antifungals
Alternative therapies
References
- ↑ 1.0 1.1 Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD (2015). "Clinical practice guideline (update): adult sinusitis". Otolaryngol Head Neck Surg. 152 (2 Suppl): S1–S39. doi:10.1177/0194599815572097. PMID 25832968.
- ↑ 2.0 2.1 Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM (2012). "IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults". Clin. Infect. Dis. 54 (8): e72–e112. doi:10.1093/cid/cir1043. PMID 22438350.
- ↑ Ozturk F, Bakirtas A, Ileri F, Turktas I (2011). "Efficacy and tolerability of systemic methylprednisolone in children and adolescents with chronic rhinosinusitis: a double-blind, placebo-controlled randomized trial". J. Allergy Clin. Immunol. 128 (2): 348–52. doi:10.1016/j.jaci.2011.04.045. PMID 21624649.