Health A-Z

Medical Content Created by the Faculty of the
Harvard Medical School

Acute Sinusitis

Treatment

Many sinus infections improve without treatment. However, several medications may speed recovery and reduce the chance that an infection will become chronic.

Decongestants — Congestion often triggers sinus infections, and decongestants can open the sinuses and allow them to drain. Several are available:

• Pseudoephedrine (Sudafed) is available without prescription, alone or in combination with other medications in multi-symptom cold and sinus remedies. Pseudoephedrine can cause insomnia, racing pulse and jitteriness. Do not use if you have high blood pressure or a heart condition. Phenylephrine (such as Sudafed PE) is an alternative over-the-counter oral decongestant. If you take products containing oral phenylephrine, check with the pharmacist to be certain there is no interaction with other medications you take.

• Oxymetazoline (Afrin, Dristan and others) and phenylephrine (Neo-Synephrine and others) are found in nasal sprays. They are effective and may be less likely to cause the side effects seen with pseudoephedrine. However, using a nasal decongestant for more than three days can cause worse symptoms when you stop the medication. This is called the rebound effect.

Antihistamines — These medications help to relieve the symptoms of nasal allergies that lead to inflammation and infections. However, some doctors advise against using antihistamines during a sinus infection because they can cause excessive drying and slow the drainage process. Over-the-counter antihistamines include diphenhydramine (Benadryl and others), chlorpheniramine (Chlor-Trimeton and others) and loratadine (Claritin). Fexofenadine (Allegra) and cetrizine (Zyrtec) are available by prescription.

Nasal steroids — Anti-inflammatory sprays such as mometasone (Nasonex) and fluticasone (Flonase), both available by prescription, reduce swelling of nasal membranes. Like antihistamines, nasal steroids can be most useful for those who have nasal allergies. Nasal steroids tend to produce less drying than antihistamines, and unlike nasal decongestants, nasal steroids can be used for prolonged periods.

Saline nasal sprays — These salt-water sprays are safe to use and can provide some relief by adding moisture to the nasal passages, thinning mucus secretions and helping to flush out any bacteria that may be present.

Pain relievers — Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin and others) can be taken for headache or sinus pain, and may reduce some inflammation.

Antibiotics — Your doctor may prescribe an antibiotic if he or she suspects that a bacterial infection is causing your sinusitis. Antibiotics help to kill bacteria and control infection. If you start taking an antibiotic, complete the entire course so that the infection is completely killed off. Not all cases of sinusitis require antibiotic treatment: Talk with your doctor about whether an antibiotic is right for you. Keep in mind that antibiotics can cause side effects, such as allergic reactions, rash and diarrhea. In addition, overusing antibiotics eventually leads to the spread of bacteria that no longer can be killed by the most commonly prescribed antibiotics.