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. Due to the problem of bacterial resistance, doctors have had to switch to different or stronger types of antibiotics to treat bacterial infections.
Amoxicillin, a type of penicillin, used to be the main antibiotic used for sinusitis but it has become less effective. Amoxicillin-clavulanate (Augmentin, generic) has replaced amoxicillin as the antibiotic recommended for treating acute bacterial sinusitis in both children and adults. It is a type of penicillin that works against a wide spectrum of bacteria.
Patients who have a history of penicillin allergy cannot take amoxicillin-clavulanate:
- For adults with sinusitis and penicillin allergies, doctors recommend either doxycycline or the fluoroquinolones levofloxacin or moxifloxacin.
- Children should not take doxycycline because it can cause tooth discoloration. Levofloxacin is the standard alternative antibiotic for children with penicillin allergies.
Other types of antibiotics, such as macrolides and trimethoprim-sulfamethoxaole, have also become ineffective for treating acute bacterial sinusitis and are no longer recommended.
Side Effects. Side effects of antibiotics vary according to the specific drug and the patient’s individual response. Many patients experience few side effects, but they many 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.)
- Allergic reactions can occur with all antibiotics but are most common with medications derived from penicillin or sulfa. These reactions can range from mild skin rashes to rare but severe, even life-threatening, anaphylactic shock.
- Certain drugs, including some over-the-counter medications, interact with antibiotics. Inform your doctor of all medications you are taking and of any drug allergies.
Nasal-spray corticosteroids, commonly called steroids, are effective drugs for treating allergic rhinitis. Although they are not approved for treating sinusitis, they may be helpful for patients with sinusitis (either chronic or acute) who have a history of allergic rhinitis. Nasal spray steroids can help reduce inflammation and mucus production.
Corticosteroids available in nasal spray form approved for treating nasal allergy symptoms include:
- Triamcinolone (Nasacort, generic). Approved for children over age 6.
- Mometasone furoate (Nasonex). Approved for use in patients as young as age 3.
- Fluticasone (Flonase, generic). Approved for children over age 4.
- Beclomethasone (Beconase, Vancenase), flunisolide (Nasalide, generic), and budesonide (Rhinocort). Approved for children over age 6.
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
- Headaches and nosebleed (these side effects are uncommon but should be reported immediately to your doctor )
Decongestants are drugs that help reduce nasal congestion. They are available in both pill and nasal spray forms. However, decongestants will not cure sinusitis. Nasal decongestants may actually worsen sinusitis by increasing sinus inflammation.
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 from their labeling all references to sinusitis. The Infectious Diseases Society of America does not recommend nasal or oral decongestants for patients with acute bacterial sinusitis.
Your doctor 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 doctor before taking a decongestant. Do not try to treat sinusitis by yourself.
Decongestants should never be used in infants and children under the age of 4 years, and some doctors recommend not giving them to children under the age of 14. Children are at particular risk for central nervous system side effects including convulsions, rapid heart rates, loss of consciousness, and death.
Antihistamines are included in many cold and allergy medications. Because they dry and thicken nasal secretions, they make sinus drainage difficult and may worsen sinusitis. Patients with sinusitis should not take antihistamines.