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Sinusitis

August 13, 2020 By Dr. G, PharmD

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Sinusitis is usually viral.  Only use antibiotics if signs and symptoms are greater than 10 days or purulent discharge with a fever greater than 102 degrees. Viral is quick, usually lasting less than a week.  Bacterial often has double sickening and purulent discharge. Do not do imaging unless immunocompromised or orbital cranial involvement. Only symptomatic relief for viral.

If Bacterial: 

  • Usually caused by H. influenza, Moraxella catarrhalis, Staph aureus, Step. Pyogenes 
  • Resistance risks: Age <2 >65, antibiotics in last month, hospital stay in the last 5 days, smoking, diabetes, cardiac disease, hepatic or renal disease, immunocompromised. 
  • Use Amoxicillin/clavulanate 500 mg TID or high dose Amoxicillin/clavulanate 875 BID if > 39-degree temp or resistance as above) 
  • Doxy is second line
  • FQs like levo or moxi in PCN allergy if doxy not available. NO MACROLIDES 
  • Cephs are not great, but cefpodoxime can be used with clindamycin. 
  • You can use inhaled steroids or saline irrigation for symptoms
  • Duration: 5-7 days 
  • Treatment failure: Consider endoscopy guided cell culture if not recovered in 3-5 days or worse in 48-72 hours. Rule out other causes.  If they didn’t get first-line therapy, try that (or try the right dose if they got substandard dosing). 

Chronic Sinusitis: 

  • Sinusitis for at least 12 weeks. 
  • Enterobacteriaceae, staph aureus, pseudomonas, ABRS pathogen, anaerobes 
  • Must have: 
    • 2 of these – mucopurulent discharge, nasal congestion, decreased sense of smell, facial pain or pressure OR 
    • 1 of these – purulent mucous or edema in middle meatus or sinus, polyps, radiographic imaging showing sinus inflammation. 
  • NO ANTIBIOTICS – SALINE IRRIGATION 

Allergic Rhinitis

  • Intranasal steroids are the first line and most effective
  • Oral antihistamines are effective and can be adjunct
  • Topical cromolyn is not very effective
  • Leukotriene receptor modifiers are not effective on their own, but they can be helpful in combo or in patients with asthma.
  • Mostly just control symptoms.
  • Can be on maintenance antihistamines, nasal steroids, or leukotriene modifiers if recurrent.  You can also try allergy shots.

Filed Under: Infectious Disease Tagged With: Updated 2020

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020