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TREATING SINUSITIS

Usually acute sinusitis gets better on its own and, in many instances, all you need to do is treat the symptoms.1,2 

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Treating the symptoms of sinusitis

Treating sinusitis with antibiotics is controversial. Even if the sinus infection is caused by bacteria, the majority of patients may get better without an antibiotic anyway.1,3 If your sinusitis is not caused by a bacteria, then antibiotics will not help.4 Mucus colour alone may not be a good indicator of a bacterial infection in sinusitis and it being thick, yellow or green does not necessarily mean that you need an antibiotic.5 Other symptoms can be more helpful in trying to make this distinction. However, there are cases where an antibiotic is needed. If your symptoms don’t get better after 7 – 10 days,2,3 if they suddenly get worse2 or are very severe to start with,1 make an appointment to see your doctor to decide if you need an antibiotic.

There are various things you can do at home to help you recover. These include treating the symptoms with over-the-counter (OTC) medications which are available from your pharmacy.1,2,6,7

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Common medications used to treat sinusitis and sinus congestion

PLEASE NOTE:  Some OTC medications are not approved or recommended for children. If you are treating your child, please consult with your doctor or pharmacist before administering OTC medication.

Mucolytics8,9

ACC 200, a registered mucolytic in South Africa is available over the counter without a prescription and acts directly on the mucus by breaking it down and making it runnier and less sticky.9,10 This makes it easier to clear the mucus by blowing or sneezing.9 N-Acetylcysteine (NAC), the active ingredient in ACC 200, has been shown to improve the rate at which mucus clears by 35%.11 Most patients report a decrease in sinus discomfort and ‘heaviness’ in the first days after starting treatment with NAC.9 NAC has been shown to be safe and effective in children from the age of two.10,12  ACC 200 can be given to children from two years of age without a prescription.10

When using OTC medications, remember that dosage instructions should always be carefully followed.

Decongestants1,2

Decongestants come in tablet form, liquids and nasal sprays.13 They relieve nasal congestion and swelling by shrinking swollen nasal tissue, reducing mucus production13 and improving airflow which can make it a little easier to breathe.14

Decongestant nasal sprays should not be used for more than three days in order to avoid rebound congestion13 (increased congestion once you stop taking the medication).15 Decongestants contain ingredients that can raise blood pressure so please consult your doctor before using decongestants if you suffer from high blood pressure, heart disease or other medical problems.13,16

Using a combination of decongestants and antihistamines may cause side effects such as agitation, sedation, dizziness, a dry mouth and headaches.17

 

References
  1. BMJ Best Practice. Acute sinusitus. Last updated: 01 Mar 2019. Available at: https://bestpractice.bmj.com/.Last accessed May 2019.
  2. BMJ Best Practice. Chronic sinusitis. Last updated: 21 Mar 2018. Available at: https://bestpractice.bmj.com/.Last accessed May 2019.
  3. Lau J et al. Diagnosis and treatment of acute bacterial rhinosinusitis: summary. In: Agency for Healthcare Researchand Quality (US) 1999.
  4. Harvard Health Publishing. What to do about sinusitis: a step-by-step approach to treating and preventing sinusitis starts with a simple nasal wash. Last updated: 02 Apr 2018. Available at: https://www.health.harvard.edu/diseases-and-conditions/what_to_do_about_sinusitis. Last accessed May 2019.
  5. Gonzales R et al. Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults: background. Clinical Practice Guideline, Part 2. Ann Intern Med 2001; 134:490-494.
  6. Rosenfeld RM et al. Clinical practice guidelines (update): adult sinusitis. Otolaryngol Head Neck Surg 2015; 152(2S):S1-S39.
  7. Hallet R and Naguwa SM. Severe rhinosinusitis. Clin Rev Allergy Immunol 2003; 25:177-190.
  8. Scaglione F and Petrini O. Mucoactive agents in the therapy of upper respiratory airways infections: fair to describe them just as mucoactive? Clin Med Insights Ear Nose Throat 2019; 12:1-9.
  9. Kryukov A.I., et al. Treatment of Acute Sinusitis. Russian Medical Journal. Otorhinolaryngology, 2012, No. 9, pp. 485-488.
  10. Sandoz SA (Pty) Ltd. ACC 200 approved package insert. May 2018.
  11. Helms S and Miller AL. Natural treatment of chronic rhinosinusitis. Altern Med Rev 2006; 11(3):196-207.
  12. Sandoz SA (Pty) Ltd. ACC 200 approved in-house clinical overview (A 3194/2016) Acetylcysteine 2016.
  13. WebMD. Cough relief: how to lose a bad cough. Last updated: 01 Jul 2015. Web MD Archives. Last accessed May 2019.
  14. WebMD. Decongestants and antihistamines for a cold. Last updated: 15 May 2019. Available at: https://www.webmd.com/allergies/what-are-histamines#1. Last accessed Jun 2019.
  15. Nursing Times. Cough and cold products banned in children under the age of 6 years. Last updated: 31 Mar 2009. Available at: https://www.nursingtimes.net/cough-and-cold-products-banned-in-children-under-the-age-of-6-years/5000034.article. Last accessed May 2019.
  16. Data on file.
  17. Schellack N and Labuschagne Q. Overview and management of colds and flu. S Afr Pharm J 2014; 81(6):19-26.