Drugs

Both over-the-counter and prescription drugs can be beneficial to sinus patients, but they're often relied on too heavily. Drugs invariably have side effects, and which can sometimes cause problems as bad as the original sinus infection.

Antibiotics

Broad-spectrum antibiotics are the drug of choice of many ENTs, and they're usually effective in killing the bacteria that cause acute sinusitis, typically Streptococcus pneumoniae, H. influenzae, and Moraxella catarrhalis (Staphylococcus aureus, Peptostreptococcus, Fusobacterium, and Prevotella may also be found in chronic sinusitis).

Sinus infections usually require a longer course of treatment with antibiotics than other infections, often two weeks and sometimes up to eight weeks, as it's difficult for systemic drugs to penetrate into the sinuses because of the relatively poor blood flow there. Some doctors even administer intravenous antibiotics in difficult cases.

Make sure you take all of the antibiotics prescribed to avoid a situation where some infection remains without your awareness and grows back resistant to the original antibiotic, requiring a new and stronger antibiotic, one with a greater risk of side effects. Some doctors recommend continuing antibiotics for one week after symptoms disappear and the mucus has turned clear.

It's best to avoid taking antibiotics for extended periods of time. One approach to avoid this is to gauge the effectiveness of whatever antibiotic you're taking. If you don't notice a significant improvement after four or five days, the antibiotic you're on may not be effective against the bacteria you're infected with. Ask your doctor to switch you to another antibiotic.

The more sinusitis attacks you have, the less effective antibiotics are, and they're often not effective at all for chronic sinusitis. Some people wind up taking antibiotics for long periods of time, which is risky. Long-term use promotes the growth of both resistant strains of bacteria and the fungus candida (Candida albicans), and it can lead to gastrointestinal problems such as cramps, nausea, vomiting, and diarrhea.

The risk of gastrointestinal upset with antibiotics can often be reduced by drinking a full glass of water when taking them and by ingesting "probiotics" such as acidophilus (Lactobacillus acidophilus) and bifidus (Bifidobacterium bifidum) bacteria, found in certain yogurts (check the label) or capsules (health food stores).

Because of their negatives, avoiding antibiotics should be your goal. Too many patients, and doctors, make the mistake of relying too heavily, even exclusively, on antibiotics in treating sinusitis. Unless you also treat the structural defects that typically accompany chronic sinusitis, particularly inactive cilia and blocked ostia, infection will persist or habitually return.

Antibiotics used to treat sinusitis include Augmentin (amoxicillin/clavulanic acid), Ceclor (cefaclor), Ceftin (cefuroxime axetil), LoraBid (loricarbef), Cefzil (cefprozil), Omnicef (cefdinir), Biaxin (clarithromycin), and Zithromax (azithromycin). They're often more effective on sinus infections, particularly recurring sinus infections that may involve resistant strains of bacteria, than older antibiotics such as amoxicillin, ampicillin, tetracycline, and erythromycin, though they cost more. Other antibiotics that are sometimes used to treat sinusitis include Cipro (ciprofloxacin), Levaquin (levofloxacin), Zagam (sparfloxacin), Avelox (moxifloxacin), Tequin (gatifloxacin), Cleocin (clindamycin), Flagyl (metronidazole), Vantin (cefpodoxime), Suprax (cefixime), and Cedax (ceftibuten).

Steroid Nose Sprays

For many people a prescription steroid nasal spray is the most effective medication for managing their sinusitis. It can shrink swollen nasal membranes, reduce mucus secretions, and help prevent or alleviate allergic reactions by reducing the number of histamine-producing mast cells in your sinuses. Steroid nasal sprays can also prevent the ostia from closing up and shrink or prevent polyps, which in some cases eliminates the need for surgery.

Steroid nose sprays are safer to use than a number of other sinus medications. They don't produce the rebound effect of nasal decongestant sprays or the kinds of serious systemic side-effects as prednisone and other oral steroids, as only a small amount of the steroid (cortisone or a cortisone-like drug) is absorbed into the bloodstream.

However, long-term use of steroid nasal sprays, particularly if you use them in quantities greater than recommended, may depress the functioning of the cilia, possibly due to the preservatives used (avoid products made with the preservative benzalkonium chloride). Long-term use may also promote the growth of candida. Occasionally steroid nasal sprays can increase inflammation -- the solution here is often to decrease the dosage or experiment with a different brand. Some doctors recommend aiming the spray away from the septum inside the nose separating the two sides to avoid the potential perforation of it.

For many people the best steroid nasal spray is a new product called Rhinocort Aqua. Older products such as Flonase and Nasonex contain alcohol, which may cause sinus irritation, and the preservative benzalkonium chloride. Newer products such as Nasacort AQ are water based instead of alcohol based but still contain benzalkonium chloride. Rhinocort Aqua contains neither alcohol nor benzalkonium chloride. Some people, however, do well with older steroid nasal sprays and may even prefer them to newer products.

Decongestants

Over-the-counter oral decongestants such as Sudafed (pseudoephedrin) are also commonly used by sinus patients. Decongestants can help relieve nasal congestion, post-nasal drip, and sinus pressure and pain.

As mild central nervous system stimulants, however, decongestants can interfere with sleep and are best taken in the morning. Decongestants may also aggravate high blood pressure, heart and thyroid disease, and glaucoma, if you have these conditions. Also avoid them if you're taking diet pills. In men with enlarged prostates decongestants can make urinating difficult.

Over-the-counter spray decongestants such as Afrin (oxymetazoline) can quickly open up clogged nasal membranes, often within ten minutes. They're less likely than oral decongestants to aggravate blood pressure, overstimulate the nervous system, or cause urinary retention.

Spray decongestants, however, are addicting. If you use them for more than three days or so and then stop, they can leave you more clogged than you were initially, so the temptation is to continue using them. They can also dry up nasal membranes and depress the action of the cilia, which can bring on or aggravate a sinus infection.

Mucolytics

Some sinus patients report positive results with guaifenesin, a mucus thinner (mucolytic) that's found in small doses in the over-the-counter cough medicine Robitussin. The prescription form may be needed for adequately large doses. You need to drink a lot of water when on guaifenesin, as it can cause extreme thirst. (Some doctors feel guaifenesin's mucus-thinning effects are a result of its prompting people to drink voluminous amounts of water, rather than the effects of the drug itself.) Side effects may include nausea and gastrointestinal upset.

Antihistamines

Antihistamines can reduce mucus secretions and sinus swelling. Second-generation prescription oral antihistamines such as Claritin, Allegra, and Zyrtec are less likely to cause drowsiness than first-generation over-the-counter antihistamines such as Benadryl (diphenhydramine hydrochloride), but some people find that Benadryl (or its generic equivalent) is more effective. Claritin, now available over the counter, is the least sedating. Zyrtec is somewhere between Claritin and Benadryl in terms of both efficacy and sedation effects.

Spray antihistamines such as the prescription Astelin or the over-the-counter NasalCrom (technically, an "antiallergic" rather than an "antihistamine" though it works similarly) are another option. Alternatively, you can dissolve one or two 50 mg capsules of Benadryl in one ounce of saline solution and make your own spray antihistamine.

Antihistamines are best used if it's clear you have allergies and are experiencing allergic symptoms, since they can dry out nasal mucous membranes, thicken mucus secretions, and compromise the cilia, leading to or prolonging infection. To help prevent nasal dryness, you can use saline nose spray throughout the day.

Pain Medications

The over-the-counter painkillers ibuprofen (in Advil, Motrin, and generic versions) and naproxen sodium (in Aleve and generic versions) can be effective in reducing sinus inflammation, swelling, and pain, more so than acetaminophen (in Tylenol and generic versions) for sinus sufferers.

You need to be careful though if you have a tendency to develop polyps, as nonsteroidal antiinflammatory drugs (NSAIDS) such as Advil, Aleve, and aspirin can worsen them in some people.