Rhinosinusitis medical therapy
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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.
- 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 
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. 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. Different antibiotics and administration routes exist for treatment of chronic rhinosinusitis :
- 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).
- 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.
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.
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