Introduction
There are two forms of sinusitis: the acute and the chronic form. The acute form occurs over a limited period of time, while the chronic form is said to last for about two to three months. This subdivision is also relevant for the treatment applied.
Which medications are used?
- Cortisone As nasal sprays, nasal sprays containing cortisone are often used in addition to saltwater sprays, as they inhibit inflammation, which can cause the paranasal sinus mucous membrane to swell. The effect of the cortisone sets in with a delay after a few days, although there are also some patients in whom the effect does not develop. In some cases, side effects such as headaches and nosebleeds occur.
In contrast to cortisone sprays, the effect of decongestant nasal sprays (saltwater sprays) is immediate.
- Painkillers Common painkillers such as ASA, ibuprofen and paracetamol can be used to treat the accompanying pain. However, these do not, like cortisone for example, combat the actual cause of the inflammation, but only alleviate the symptoms, so that the duration of the disease is not shortened.
- Decongestant nasal sprays Decongestant nasal sprays are often recommended by treating physicians. They reduce the swelling of the mucous membranes with rapid onset of action, allowing better nasal breathing and better sleep at night.
However, these nasal sprays do not have an anti-inflammatory effect like cortisone sprays, so they only have a short-term effect. If they are used too frequently, a so-called “rebound effect” occurs, in which the nasal mucosa swells again immediately after the effect subsides. The more frequently the spray is used, the more pronounced this rebound effect is.
For this reason, these decongestant nasal sprays should not be used for longer than a maximum of seven to ten days. In the course of this, there is a risk of developing a dependency so that the nasal mucosa no longer swells without these sprays. This is known as rhinitis medicamentosa or rhinitis atrophicans.
The active ingredients belong to the so-called alpha-sympathomimetics. These are substances that mimic the action of the sympathetic nervous system by exerting a vasoconstrictive effect, which means that the vessels of the nasal mucosa become constricted, causing the mucosa to swell. The most common ingredient of the decongestant nasal sprays is xylometazoline, furthermore, oxymetazoline and tramazoline are also frequently found as ingredients.
These decongestant sprays are available in pharmacies, but not on prescription. Side effects of decongestant nasal sprays may include headaches and dizziness.
- There is also the option of treatment with the herbal medicine Sinupret ®forte or Sinupret® drops.
Antibiotics are rarely used to treat sinusitis, since antibiotics are only effective against bacteria and sinusitis is usually caused by viruses where antibiotics have no effect. Even if a bacterial pathogen has been proven to be the cause, antibiotics only help very few, because in most cases a sinusitis heals even without drug intervention.
However, if the symptoms persist for a longer period of time, antibiotics can be considered again by a doctor. Overall, as with other diseases, antibiotics should be used neither unnecessarily nor for mild illnesses in order to avoid an increasing development of resistance of the pathogens. However, if a severe course of the disease becomes apparent, the use of antibiotics is irreplaceable to protect against further complications, such as meningitis.
Characteristics of a severe course are high fever, swelling around the eyes, severe facial pain, sensitivity to light, inflammatory redness of the skin and stiff neck. In acute sinusitis, the antibiotic of first choice is the antibiotic amoxicillin. This is usually prescribed for a period of 5 to 10 days in a dosage of 500 mg three times a day.
Amoxicillin is effective against the common pathogens of acute sinusitis and is well tolerated. Side effects such as allergic reactions, nausea, vomiting and diarrhea may occur. Alternatively azithromycin can be prescribed in the same dosage.
Cefuroxime is another alternative, for example in the case of intolerance to the first two antibiotics. Cefuroxime is prescribed in a dosage of 250 mg twice daily.In addition to first choice antibiotics, there are also second choice drugs. These can be used if the first choice antibiotics are not tolerated or do not work well.
Antibiotics of the second choice are for example macrolides, doxycilin or amoxicillin+clavulanic acid. Which antibiotic is then best suited is determined by various criteria. These include, for example, tolerability, the general condition of the patient and locally known resistance to pathogens.
In chronic sinusitis, the benefit of antibiotics is very controversial. In individual cases, a therapy trial of several weeks with the antibiotic Roxithromycin in the dosage 150mg per day or Cefuroxime/Amoxicillin + clavulanic acid can be considered. It is not always necessary to intervene with medication, natural products are also often used.
One of the most frequently recommended remedies for sinusitis is the essential oil of myrtle by doctors. It has an anti-inflammatory effect and is available in capsule form in pharmacies. Also effective are the roots of the primrose.
The ingredients liquefy the secretion and thus promote sputum. The roots can be taken in the form of tea. A steam bath is also often used, which is mixed with thyme, chamomile and lavender.
Each of the three herbs has its own effect. Thyme has an antibacterial and expectorant effect, while chamomile has an anti-inflammatory effect and limits the growth of bacteria. Lavender also promotes blood circulation.
For the steam bath the herbs are first boiled. Also the extract of the Cape Pelargonium root (Umckaloabo) can generally be used for respiratory tract infections. Umckaloabo has an antimicrobial effect and strengthens the body’s overall defenses.
Care should be taken when using essential oils, especially in children, as they often contain menthol or similar substances that can cause respiratory arrest in small children. Children under two years of age should not come into contact with essential oils, and older children should also be careful when using them. Irradiation with red light via an infrared lamp can also be beneficial for healing, as repeated irradiation with red light reduces the inflammation.
Sinusitis is mostly caused by viruses. Diseases caused by viruses do not respond to antibiotics. Antibiotics are only effective against bacteria.
Therefore, a general administration of antibiotics does not make sense for sinusitis. The healing process cannot be accelerated and the careless consumption of antibiotics only promotes additionally that bacteria become resistant and respond less well to medication. Therefore, antibiotics are only prescribed very cautiously for sinusitis.
There are, however, cases in which an antibiotic is quite useful. Seldom, sinusitis is also caused by bacteria. Mostly it is then however a so-called secondary infection.
This means that first a virus caused the inflammation. Then a bacterial pathogen attaches itself additionally and a bacterial secondary infection develops. However, in practice it is not always so easy to distinguish a bacterial infection from a viral infection.
For this reason, antibiotics are only prescribed in cases of very severe pain with a high fever above 38.5 °C and high levels of inflammation in the blood. The CRP value, which is considered high from a value of 10 mg/l, and the blood sedimentation rate (men >10mm/h, women >20 mm/h) are measured. A further reason for a therapy with antibiotics is the threat of complications, such as an abscess or venous thrombosis.
Ultimately, an antibiotic should be considered useful if certain bacteria (Pneumococcus, Moraxella Catarrhalis, Haemophilus influenza) can be reliably detected in the nasal swab. In people with an immune deficiency, the use of antibiotics should be considered even without the presence of these criteria. In the case of chronic sinusitis, it is very controversial whether antibiotics are of any benefit at all. In some cases, a therapy lasting several weeks can be considered. This is decided individually.
