Sinusitis (cont.)
How is sinus infection treated?
For sinusitis caused by virus
infection, no antibiotic treatment is required. Frequently recommended
treatments include pain and fever medications (such as acetaminophen/Tylenol)
and decongestants. Bacterial infection of the sinuses is suspected when facial
pain, pus nasal discharge and symptoms persist for longer than a week and are
not responding to over-the-counter nasal medications. Acute sinus infection from
bacteria is usually treated with antibiotic therapy
aimed at treating the most common bacteria known to cause sinus infection,
since it is unusual to be able to get a reliable culture without aspirating
the sinuses. The five most common bacteria causing sinus infections are
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis,
Staphylococcus aureus,
and Streptococcus pyogenes. The antibiotics that are
effective treatment for sinus infection must be able to kill these bacterial
types. Amoxicillin (Amoxil) is an acceptable first antibiotic for an
uncomplicated acute sinus infection. In the penicillin allergic patient, cefaclor
(Ceclor), loracarbef (Lorabid), clarithromycin (Biaxin), azithromycin (Zithromax), sulfamethoxazole and
trimethoprim
(Bactrim, Septra) may be used as first choices. If a patient is not improving
after five days of treatment with amoxicillin, the patient may be switched to
one of the above drugs or amoxicillin-clavulanate
(Augmentin). Generally an effective
antibiotic needs to be continued for a minimum of 10-14 days. It is however not
unusual to need to treat sinus infection for 14-21 days. Taking decongestants (pseudoephedrine) and
mucolytics (guaifenesin) orally may be helpful
in assisting drainage of sinus infection. In general, antihistamines should
be avoided unless it is felt that the sinus infection is due to allergy, such as
from pollens, dander, or other environmental causes. It is likely that the use
of a topical
nasal steroid spray will help
reduce swelling in the allergic individual without the drying that is caused by
using antihistamines. The treatment of chronic forms of sinus infection require
longer courses of drugs such as Augmentin and may require a sinus drainage
procedure. This drainage typically requires a surgical operation to open the blocked sinus under general anesthesia.
Next: What are complications of sinus infection? »
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