Usually viral. Only use antibiotics if signs and symptoms greater than 10 days and purulent discharge, fever greater than 102 degrees, headache, increase nasal discharge
- Amoxil/ clavulanate or doxycycline if PCN allergic. Can use macrolide (drug/drug) or fluoroquinolone if resistance suspected. Can also use Bactrim (but renal dose, can be resistant and warfarin interaction with Bactrim). Treat for 5-7 days.
- Avoid use of antihistamines, analgesics and 0.9% nasal spray.
- 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 is 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.