For sinusitis caused by virus infection, no antibiotic treatment is required. Frequently recommended treatments include pain and fever medications (such as acetaminophen [Tylenol]), decongestants and mucolytics.
Bacterial infection of the sinuses is suspected when facial pain, nasal discharge resembling pus, and symptoms persist for longer than a week and are not responding to OTC 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. Although amoxicillin (Amoxil) is an acceptable first antibiotic for an uncomplicated acute sinus infection, many physicians choose amoxicillin-clavulanate (Augmentin) as the first-line drug for treatment of a suspected bacterial sinus infection because it is usually effective against most of the species and strains of bacteria that cause the disease.
In the penicillin allergic individual, cefaclor (Ceclor), loracarbef (Lorabid), clarithromycin (Biaxin), azithromycin (Zithromax), sulfamethoxazole (Gantanol), trimethoprim (Bactrim, Septra) and other antibiotics 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.
The treatment of chronic forms of sinus infection requires longer courses of medications, 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. In general, antihistamines should be avoided unless it is felt that the sinusitis 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 although both are occasionally used.
In many people, allergic sinusitis develops first, and later, bacterial infection occurs. For these individuals, early treatment of allergic sinusitis may prevent development of secondary bacterial sinusitis.
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