Rhinosinusitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]


Supportive therapy is the mainstay of treatment for cases of both acute and chronic rhinosinusitis. Antibiotics can be added in select cases of both types of rhinosinusitis.

Medical Therapy

Supportive Therapy

Supportive therapy for symptomatic relief is the mainstay of treatment in both cases of acute and chronic rhinosinusitis. Therapeutic approaches include:[1][2]

  • Analgesics and antipyretics, to manage the fever and facial pain associated with rhinosinusitis
  • Saline irrigation, which helps relieve nasal obstruction
  • Intranasal corticosteroids, which proved to be beneficial in both acute and chronic rhinosinusitis
  • Topical corticosteroids
  • Oral glucocorticoids can be given for a short period in cases of chronic rhinosinusitis with polyps [3]


In addition to symptomatic relief, antibiotics can be added in the case of acute bacterial rhinosinusitis if no improvement is observed within 10 days of supportive treatment, if symptoms worsen after initial improvement, or if symptoms are severe at initial presentation.[1][2] As for acute bacterial rhinosinusitis, first line antibiotic is amoxicillin alone or in combination with clavulanate. In case of resistance or allergy, second line treatment including trimethoprim-sulfamethoxazole, doxycycline and fluoroquinolones are prescribed for preferably less than 10 days.[4][5] Different antibiotics and administration routes exist for treatment of chronic rhinosinusitis [5]:

  • Oral macrolides: This group of antibiotics are used for treatment of chronic rhinosinusitis with polyps and have antibacterial and anti-inflammatory effects. They inhibit the cytokine release such as IL8, pro-inflammatory transcription factors such as NF-Kβ and impair the neutrophil function (i.e. migration, adhesion and oxidative response).[6][7]
  • Intravenous (IV) antibiotics: Due to high incidence of adverse effects subsequent to IV antibiotics, thus it is only is indicated only in a few conditions:
    • Extranasal complications of chronic rhinosinusitis
    • Resistance to oral antibiotics
    • Allergy or intolerance to oral antibiotics
  • Topical antibiotics: Direct delivery to the nasal mucosa, increased local absorption and efficacy. The disadvantages are local adverse effects, dependence to the delivery technique and unknown long-term effects.


Oral antifungals are specially suggested in patients with eosinophilic inflammation. There are limited evidence regarding its efficacy in treatment of chronic rhinosinusitis with polyps and further investigation is required prior to recommendation.[5][8]

Alternative therapies

Several agents have been suggested as alternative therapies for chronic rhinosinusitis including surfactant, manuka, xylitol and colloidal silver. However, There are limited, conflicting evidence in the literature regarding their efficacy in treatment of chronic rhinosinusitis, thus no recommendation is yet possible.[5]


  1. 1.0 1.1 Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD (2015). "Clinical practice guideline (update): adult sinusitis". Otolaryngol Head Neck Surg. 152 (2 Suppl): S1–S39. doi:10.1177/0194599815572097. PMID 25832968.
  2. 2.0 2.1 Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM (2012). "IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults". Clin. Infect. Dis. 54 (8): e72–e112. doi:10.1093/cid/cir1043. PMID 22438350.
  3. Ozturk F, Bakirtas A, Ileri F, Turktas I (2011). "Efficacy and tolerability of systemic methylprednisolone in children and adolescents with chronic rhinosinusitis: a double-blind, placebo-controlled randomized trial". J. Allergy Clin. Immunol. 128 (2): 348–52. doi:10.1016/j.jaci.2011.04.045. PMID 21624649.
  4. Fokkens WJ, Lund VJ, Mullol J, Bachert C, Alobid I, Baroody F; et al. (2012). "European Position Paper on Rhinosinusitis and Nasal Polyps 2012". Rhinol Suppl. 23: 3 p preceding table of contents, 1–298. PMID 22764607.
  5. 5.0 5.1 5.2 5.3 Orlandi RR, Kingdom TT, Hwang PH, Smith TL, Alt JA, Baroody FM; et al. (2016). "International Consensus Statement on Allergy and Rhinology: Rhinosinusitis". Int Forum Allergy Rhinol. 6 Suppl 1: S22–209. doi:10.1002/alr.21695. PMID 26889651.
  6. Cervin A, Wallwork B (2005). "Anti-inflammatory effects of macrolide antibiotics in the treatment of chronic rhinosinusitis". Otolaryngol Clin North Am. 38 (6): 1339–50. doi:10.1016/j.otc.2005.08.002. PMID 16326189.
  7. Lin HC, Wang CH, Liu CY, Yu CT, Kuo HP (2000). "Erythromycin inhibits beta2-integrins (CD11b/CD18) expression, interleukin-8 release and intracellular oxidative metabolism in neutrophils". Respir Med. 94 (7): 654–60. doi:10.1053/rmed.1999.0781. PMID 10926336.
  8. Kennedy DW, Kuhn FA, Hamilos DL, Zinreich SJ, Butler D, Warsi G; et al. (2005). "Treatment of chronic rhinosinusitis with high-dose oral terbinafine: a double blind, placebo-controlled study". Laryngoscope. 115 (10): 1793–9. doi:10.1097/01.mlg.0000175683.81260.26. PMID 16222197.

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