SAN FRANCISCO — Antibiotics are necessary for some cases of rhinosinusitis, but many patients will improve with a simple saline nasal wash, Ralph Gonzales, M.D., said at the annual meeting of the American College of Physicians.
A nasal wash will clear out concretions blocking the sinus os and sinus cavities, allowing the sinuses to drain. “I recommend them for most patients,” said Dr. Gonzales of the department of medicine at the University of California, San Francisco.
“When you get people actually using it, I have had very positive reports,” he added.
The wash can be done with contact lens cleaner solution. Patients should hold a small amount in a cupped hand, close one nostril, and draw it in, hard enough to irrigate the sinuses but not so forcefully that they swallow it, Dr. Gonzales said. He has them perform the wash two to three times a day, during which time they can use an NSAID for pain if needed.
According to guidelines, physicians should reserve antibiotics—after evaluation for a possible bacterial infection—for those cases with moderately severe symptoms that have lasted at least 7–10 days, he said.
The evidence that antibiotic treatment is beneficial in acute rhinosinusitis is not definitive, he said. Some studies have not demonstrated an advantage over placebo. However, the studies that have been most rigorous in diagnosis have tended to show somewhat greater cure or improvement rates, suggesting that there really are some patients that need antibiotics.
Dr. Gonzales pointed out that sinusitis can be serious, even life threatening. Patients with focal unilateral maxillary pain and fever may have orbital cellulitis. In these cases there is often redness and tenderness around the maxillary sinus; Staphylococcus aureus is often the cause. These infections can be aggressive, sometimes fatal.