Acute Sinusitis

Majid Ali, M.D.

Summarized From NEJM 2016375:962


 

Sinusitis is inflammation of the paranasal sinuses and nasal cavity. It is estimated to affect nearly 30 million adults annually in the United States. It is classified according to duration as acute (lasting up to 4 weeks), chronic (lasting more than 3 months), or subacute (lasting between 4 weeks and 3 months). Although most episodes of acute sinusitis are caused by viral upper respiratory tract infections, they are also associated with asthma, allergic rhinitis, smoking, and exposure to secondhand smoke.2-5 Sinusitis is often called rhinosinusitis because the inflammation involves the paranasal sinuses and nasal mucosa.


When prescribing antibiotics, I always cover antibiotics with kefer drink (four ounces, as a source of probiotics) and Nystatin as a preventive against overgrowth of fermenting gut flora. I also prescribe Nutti pot sinus lavage and vitamin C (1000 mg) plus turmeric powder (2000 mg) four times a day. 


Main Clinical Points of Acute Sinusitis in Adults

  • The diagnosis of acute bacterial sinusitis is based on the presence of purulent nasal discharge accompanied by nasal obstruction; facial pain, pressure, or fullness; or both that persists for at least 10 days without improvement or worsens within 10 days after initial improvement.

  • Analgesics, nasal irrigation with saline, and topical intranasal glucocorticoids or decongestants may be used to relieve symptoms.

  • Randomized trials that primarily involve otherwise healthy nonpregnant adults seen in primary care settings have compared watchful waiting (without antibiotics) with initial antibiotic therapy. These trials have shown small clinical benefits of antibiotics over placebo (number needed to treat to reduce symptoms, 7 to 18). Both of these approaches are valid initial management options.

  • Watchful waiting is offered only if the clinician is sure that the patient will return for follow-up if the symptoms do not decrease. Antibiotic therapy is initiated if the patient’s condition has not improved by 7 days after diagnosis or if it worsens at any time. If antibiotics are used, amoxicillin or amoxicillin–clavulanate are recommended as first-line therapy.


 

I always cover antibiotics with kefer drink (as a source of probiotics) and Nystatin as a preventive against overgrowth of fermenting gut flora. I also prescribe Nutti pot sinus lavage and vitamin C (1000 mg) plus turmeric powder (2000 mg) four times a day.

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