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Acute bacterial rhinosinusitis
Principles of appropriate antibiotic use for acute rhinosinusitis apply to the diagnosis and treatmentof acute maxillary and ethmoid rhinosinusitis in otherwise healthy adults.
Sinus inflammation is often viral and usually resolves without antibiotics.
■ Patients may rarely present with severe
symptoms of bacterial rhinosinusitis less
sinusitis). Consider immediate referral to
■ Most cases of acute rhinosinusitis are
due to uncomplicated viral infections.
uncomplicated bacterial rhinosinusitis.
– Opacification and air-fluid level have
(J Clin Microbiol
1997; 35:2864; JAMA
of 80% (J Clin Epidemiol
■ Bacterial rhinosinusitis may be present
patients with viral infections (J Allergy
and there is localization to the maxillary
rhinosinusitis improve without antibiotic
– About 81% of antibiotic-treated patients
10-14 days (absolute benefit of 15%).
■ Patients with mild symptoms should not
– Most randomized trials of symptomatic
health department formore information and
covers S. pneumoniae
and H. influenzae
choice for uncomplicated infections.
rhinosinusitis in adults: Background.
increase the predictive value of
Topic: General Respiratory Illness and Influenza Symptom Management
Below are general guidelines to help you manage your respiratory symptoms. In general, combination products (Tylenol
Cold & Sinus, Dayquil, etc) are not as effective as taking the individual components because of differences in dosing.
Also, generics are MUCH less expensive. All items listed are available in the UHC Pharmacy.
Get more than the usual amount of rest. If you have fever or are taking medicine to reduce fever, you should not
exercise until fever is gone and you feel better. In general, limit extracurricular activity until you are well. This
should shorten the healing process.
Drink plenty of fluids (~2-3 liters/day). This thins mucous, helps your immune system work and lessens fever.
Humidify your room by running a cool mist vaporizer or humidifier, particularly at night. Keep the machine
clean and replace filters regularly. Placing a pan of water by the bedside and steamy showers can also help.
Antibiotics are not typically helpful, but if prescribed complete the course as directed until gone. Take all other
prescribed medications as directed. If you areprescribed an inhaler use it with a spacer to maximize
Warm saltwater (1/2 tsp salt in 1 cup warm water) gargles every 2-3 hours to soothe your throat. This will
provide temporary relief and help to thin out excess mucus. Lozenges will also help to soothe your sore throat.
Nasal saline rinses thin mucous, decrease congestion, reduce mucous production and decrease postnasal
drainage. In general, it helps to promote a healthy environment in the sinuses and reduce your risk for
developing a sinus infection. In the event that an infection does develop, it helps to reduce the sympto
saline rinses are best achieved with the use of a neti pot, which can be purchased at low cost in the UHC
pharmacy. Spray bottles, commercial products such as Ocean Mist and simply “snuffing” saline from your
cupped hand may also be helpful and are also available in the UHC pharmacy.
Elevate the head of your bed 15-20 degrees to help promote sinus drainage and lessen sinus pressure.
For fever and/or pain: Acetaminophen (Tylenol) regular strength (325 mg)-2 tabs every 4 hours OR Extra
Strength Acetaminophen, 2 tablets up to 4 times a day. May be taken alone or in combination with ONE of the
following: Ibuprofen (Advil, Motrin) 200 mg- 4 tablets every 8 hours with food and full glass of water OR
Naproxen (Aleve) 220 mg- 2 tablets every 12 hours with food and full glass of water. Ibuprofen and Naproxen
have anti-inflammatory effects as well as help to control pain and fever, but may cause stomach irritation.
For nasal congestion/stuffiness Pseudoephedrine XR (Sudafed XR) 120 mg (requires signature with pharmacist) -
1 capsule every 12 hours. Try not to take after 7 pm as this medicine can sometimes make it difficult to get to
Phenylephrine HCL (10 mg), 1-2 tablets taken three times a day as needed, is a decongestant that is both
effective and less likely to cause heart palpitations or disturb your sleep than pseudoephedrine.
For severe nasal congestion/stuffiness and for immediate relief, use Oxymetazoline HCl (Afrin) nasal spray. Use
one spray in each nostril twice daily for no more than 3 days OR one spray in each nostril at bedtime for no more
than 6 days. Using this medicine longer or more often than recommended can cause rebound nasal stuffiness.
For thickened mucus/cough: Guafenesin/Dextromethorphan products (Robitussin DM, Mucinex DM) are good
cough suppressants and can be taken along with one of the decongestants above. Mucinex is a tablet form of
guafenesin and helps thin out mucus. Mucinex-D is helpful if you need a decongestant instead of a cough
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