Treatment for Acute Sinusitis
While it is very difficult to distinguish between bacterial and viral sinus infections, many primary care physicians choose to treat acute sinusitis with antibiotics. To help determine the effectiveness of antibiotics, a recent study published in The Journal of the American Medical Association utilized amoxicillin and topical budesonide in treating acute, nonrecurrent, maxillary sinusitis.

In the study, primary care patients were divided into four treatment groups: oral amoxicillin and budesonide nasal, placebo antibiotic and the nasal steroid, oral antibiotic and placebo nasal steroid, or placebo antibiotic and placebo nasal spray. The results of the study found that neither the antibiotic nor topical steroid alone, or in combination, were effective as a treatment for acute sinusitis in the primary care setting. So what is the best approach for treating acute sinusitis?

At CornerStone Ear, Nose & Throat, we suggest that the initial treatment should target the symptoms and include antipyrectics and analgesics, along with a short course of topical or systemic decongestants (unless contraindicated). Reassure patients that the symptoms should begin to improve in approximately a week. However, if symptoms do not improve after two weeks, or if the patient develops pulmonary symptoms, then a prescription for an antibiotic is appropriate. An ENT referral is indicated if the symptoms are not resolved within three to four weeks of treatment, if the patient requires chronic use of decongestants, or if the patient has more than three episodes of sinusitis a year.

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