Prescription Treatment For Chronic Sinusitis

Chronic sinusitis (CRS) is defined as 12 weeks of sinus and/or nasal inflammation with symptoms that include facial pain/pressure, smell that is decreased or lacking, nasal drainage, and nasal obstruction. To make a diagnosis, physical findings of purulent drainage of CT findings of infection should accompany the symptoms.

There are numerous causes, but that would require a separate newsletter.

Today’s article is to give you some guidance on how CRS should be treated. Implied in the guidance is that you are healthy, have no significant medical problems, and aren’t pregnant. Most of these recommendations require a prescription. If you have had sinus problems for 12 weeks, it is unlikely that natural or OTC remedies will cure them.

However, these links to previous newsletters may help you find options to help with the symptoms: “Natural Remedies” and “OTC Options”

Basics of Treating Chronic Sinusitis

• 3 weeks of a broad-spectrum antibiotic such as Augmentin or Doxycycline. Of course, adjust based on medication allergies.

• I often see patients who have been treated with these medications for 7-10 days. These short treatments won’t solve CRS.

• Oral steroids such as a Medrol Dose-Pak or 5 days of prednisone.

• I am not convinced that a nasal antihistamine (Astepro, azelastine, olopatadine, etc.) is of any benefit in treating CRS, but most insurance companies require that patients with CRS be given a prescription for these medications.

• A CT scan after treatment is standard to ensure that the infection has cleared. These should be in-office CT scans that have a low radiation dose.

• If you get to the point that you need this amount of treatment, you should be seeing an ENT or allergist.

• If you fail to respond to treatment or you respond and then have a prompt recurrence, surgery is sometimes needed.

Till next week,
Jim Atkins, MD, Follow me on Twitter.
Lori Atkins, PA-C

P.S.

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