Antibiotic drugs are used to treat bacterial, not viral, infections. Unfortunately, because of the overuse and improper use of antibiotics, many types of bacteria no longer respond to antibiotic treatment. The bacteria have become resistant to these drugs.
Amoxicillin, a type of penicillin, is the main antibiotic used for mild-to-moderate acute bacterial sinusitis, but due to bacterial resistance it has become less effective. Amoxicillin-clavulanate (Augmentin, generic) may be used as an alternative to amoxicillin. It is a type of penicillin that works against a wide spectrum of bacteria.
People who have a history of penicillin allergy cannot take amoxicillin or amoxicillin-clavulanate. They will need to take another type of antibiotic such as doxycycline or levofloxacin.
Side effects of antibiotics may include:
- Upset stomach.
- Vaginal infections (taking supplements of acidophilus or eating yogurt with active cultures may help restore healthy bacteria that offset the risk for such infections)
- Interactions with certain drugs, including some over-the-counter medications. Inform your doctor of all medications you are taking and of any drug allergies.
- Allergic reactions can range from mild skin rashes to rare but severe, and even life-threatening anaphylactic shock.
Nasal-spray corticosteroids, commonly called nasal steroid sprays, help reduce inflammation and mucus production. They may take up to several weeks of use to have an effect.
Corticosteroids that are available in nasal spray form and are approved for treating nasal allergy symptoms include:
- Triamcinolone (Nasacort Allergy HR)
- Mometasone furoate (Nasonex)
- Fluticasone (Flonase)
- Beclomethasone (Beconase, Vancenase), flunisolide (Nasalide), and budesonide (Rhinocort)
- These nasal sprays are also approved for children (ages vary depending on brand)
Side Effects: Corticosteroids are powerful anti-inflammatory drugs. Although oral steroids can have many side effects, the nasal-spray form affects only local areas, and the risk for widespread side effects is very low unless the drug is used excessively.
Side effects of nasal corticosteroids may include:
- Dryness, burning, stinging in the nasal passage
- Nosebleed (inform your health care provider)
When taking a nasal steroid spray, it is very important that you direct the tip of the bottle towards the cheek or eye on that side of the face. This will direct the medicine towards the swollen glands and sinus passages and away from the central septum or cartilage which can be the source of nosebleeds. Also, do not sniff in deeply while using the spray because this directs all the medicine into the back of your nose and into your mouth instead of keeping it inside the nose where it should be.
Decongestants are drugs that help reduce nasal congestion. They are available in both pill and nasal spray forms. However, decongestants will not cure sinusitis. They may actually worsen sinusitis by increasing sinus inflammation if used too long. Nasal spray decongestants should not be used for more than 3 days in a row.
Due to the lack of evidence for the benefit of nasal decongestants in treating sinusitis, the FDA ordered manufacturers of over-the-counter (OTC) nasal decongestant products to remove all references to sinusitis from their labeling. The Infectious Diseases Society of America does not recommend nasal or oral decongestants for patients with acute bacterial sinusitis.
Your health care provider may still recommend that you take either an OTC or prescription nasal decongestant to help relieve blockage symptoms associated with sinusitis. If you think you have sinusitis, check with your provider before taking a decongestant.
Decongestants should never be used in infants and children under age 4, and some doctors recommend not giving them to children under age 14. Children are at particular risk for central nervous system side effects, including convulsions, rapid heart rate, loss of consciousness, and death.
Antihistamines such as diphenhydramine (Benadryl, generic) are included in many cold and allergy medications. Because they dry and thicken nasal secretions, they make sinus drainage difficult and may worsen sinusitis. In general, people with sinusitis should not take antihistamines.