Highlights
New Sinusitis Guidelines
In 2005, the American Academy of Allergy Asthma & Immunology and the American College of Allergy Asthma & Immunology released joint guidelines on the diagnosis and management of sinusitis.
- Sinusitis is classified as acute, subacute, recurrent, or chronic depending on how long symptoms last.
- Colds and flu, and allergic rhinitis, are the conditions that most often lead to sinusitis. Otitis media and asthma are often associated with sinusitis.
- Most cases of sinusitis can be diagnosed by examining the patient and asking them about their symptoms. Imaging tests such as CT scans are usually not required, although they can be helpful in showing structural abnormalities.
- Antibiotics should be withheld 10 to 14 days unless severe symptoms develop. These symptoms include fever, facial pain or tenderness, or swelling around the eye.
- The first type of antibiotic treatment tried is a 10 to 14 day course of amoxicillin or trimethoprim-sulfamethoxazole. If patients do not respond or are resistant to these drugs, then other antibiotics may be prescribed.
- Surgery is a last resort.
New Cough Guidelines
Patients with sinusitis sometimes take cough medicines to treat cough caused by postnasal drip (also called upper airway cough syndrome). New guidelines from the American College of Chest Physicians recommend:
- Adults should not use over-the-counter (OTC) expectorants or cough suppressants. These products do not help relieve cough.
- Instead, adults should use the antihistamine diphenhydramine (Benadryl) and a decongestant in pill form such as pseudoephedrine (Sudafed).
- Children age 14 years and younger should not use OTC cough and cold medicines.
Nasal Decongestants
The FDA has ruled that OTC nasal decongestants’ labels must not make any claims about sinusitis. There is no evidence that nonprescription nasal sprays and drops help sinusitis. These products can actually make sinus congestion and inflammation worse. Check with your doctor before taking a nasal decongestant.
Drug Warnings
Some cases of serious liver injury were reported after the approval of telithromycin (Ketek) for the treatment of sinusitis and other lung problems. In June 2006, the FDA reported that four people had died after taking the drug. The FDA ordered the manufacturer to add a warning to the drug’s label. In December 2006, the FDA recommended that Ketek should not be used in patients with sinusitis or bronchitis.
