The organisms which cause acute sinusitis are the same as those that cause acute otitis media (middle ear infection).  (In some respects, the ear can be thought of as a specialized sinus cavity.)  However a major difference between the treatment of a bacterial infection of the sinuses and otitis media (middle ear infection) is the duration of treatment.  Bacterial sinusitis is, especially if chronic, is treated for three weeks as an otitis media (middle ear infection) is usually treated for 10 days (sometimes even less).  In 2004, the American Academy of Otolaryngology and head and neck surgery for antibiotic treatment of acute bacterial rhinosinusitis are:  (NOTE:  These recommendations may change and as with any recommendation may be out of date by the time of publication.  Thus, always consult your physician or health care provider.)

If no recent antibiotics given in last 4 to 6 weeks and the patient is NOT allergic to penicillin

Amoxicillin/Clavulanate (Augmentin), Amoxicillin, Cefpodoxime proxetil (Vantin), Cefuroxime axetil (Ceftin) and Cefdinir (Omnicef)   

If no recent antibiotics given in last 4 to 6 weeks and the patient IS allergic to penicillin

TMP/SMX (Septra), Azithromyxin (zithromax), Clarithromyxin (Biaxin), and Erythromycin

If recent antibiotics given in last 4 to 6 weeks and the patient is NOT allergic to penicillin

Amoxicillin/Clavulanate (Augmentin), Ceftriaxone (Rocefin)   

If recent antibiotics given in last 4 to 6 weeks and the patient IS allergic to penicillin

TMP/SMX (Septra), Azithromyxin (zithromax), Clarithromyxin (Biaxin), Erythromycin, and Clindamycin.

NOTE:  Zithromax and Biaxin are not recommended unless the patient is allergic to penicillin.  As of Jan 2004 these antibiotics have a failure rate up to 25%. 

Antimicrobial Treatment Guidelines for Acute Bacterial Rhinosinusitis 2004
Otolaryngology-Head and Neck Surgery,  Supplement 1, Vol. 130 No. 1  Jan 2004

Medial Management of Acute Bacterial Sinusitis   Recommendations of a Clinical Advisory Committee on Pediatric and Adult Sinusitis.  Annals of Otology, Rhinology and Laryngology,  2000
 

Unilateral sinusitis is a "Red Flag" and all patients should be evaluated for a foreign body and neoplasm.  Patients at high risk for developing nasal carcinoma (cancer) are those who smoke, are woodworkers, or are exposed to other carcinogens ( chemicals causing cancer).

If a "Cold" is associated with throat discomfort a health care professional may obtain a throat culture or screen for Streptococcus Pneumonia or "Strep".   If a positive result is obtained the patient should be placed on an antibiotic in order to prevent Rheumatic Fever, a serious heart condition.  Often a "Cold" is caused by a virus.  If so, the best treatment is often fluids, rest, and supportive over-the-counter medications.  If symptoms last for more than 2 weeks, a more serious condition may be present and reconsultation with a  medical professional should be obtained.

#1. Decongestant: These medications open the nasal passages. They do so by constricting blood vessels. These medications can relieve airway obstruction, pressure symptoms and help the sinuses to drain. Unfortunately, they all may elevate blood pressure, cause a more rapid heart beat, cause more irregular heartbeats and cause insomnia. They should not be taken if you have high blood pressure, a heart condition, diabetes or insomnia. Decongestants can raise blood pressure and increase the heart rate. In diabetics, they can decrease insulin requirements which can lead to life threatening low blood sugar. In addition, these drugs may cause dangerous reactions if you are on MAO inhibitors or anti-Parkinson medications.      Search PubMed for Nasal Decongestants

Decongestant nose sprays are also available and should only be used for 3 days and only 2 to 4 times a day or addiction can occur. When addicted, a condition called rhinitis medicamentosa occurs. This condition produces only a short period of relief with use of the nose spray and severe nasal symptoms when the nose spray is not use. It is very difficult to treat and difficult to withdraw the patient from the nose spray.

Most common over-the-counter nose sprays are: Afrin (Oxymetazoline HCL), Neosynephrine (Phenylephrine HCL) and Dristan (Phenylephrine HCL and Pheniramine Maleate).

Alert!!  Decongestants containing phenylpropanolamine have been recalled by the FDA because of potential adverse effects on the cardio-vascular system, with the potential to cause heart attacks, high blood pressure and strokes.  Common over-the-counter medications which contain phenylpropanolamine are :  Travist-D, Triaminic Products, Dimetapp Products, Alka-Seltzer "Cold" products and Contact Products.  Note:  Not all dimetapp and triaminic products contain phenylpropanolamine. 

Alert!!  Decongestants containing pseudoephedrine are now behind-the-counter.  Medications containing this drug have restricted sales, since they can be used in cooking methamphetamine.   In some States these medications are sold by prescription only.   It is advisable to first try the over-the-counter formulation, such as Pseudofed PE, which contains phenylephrine. 

#2. Cough Medication: Contained in some of the "Cold" preparations. Some may be addicting and cause drowsiness.

#3. Pain Medication: Most products with an analgesic or pain medication use Acetaminophen or Tylenol. These medications not only relieve pain but also will help reduce a fever. A few use Ibuprofen (Advil Cold and Sinus) which is a drug similar to aspirin, and should not be used in aspirin sensitive patients. Many "Cold" and "Sinus" medications contain acetaminophen and if used together an overdosage may occur which can cause damage to the liver. Acetaminophen can also cause kidney damage if used for a prolonged period. And of course you should not mix these medications with other pain medications such as regular "Tylenol".

#4. Moisturizer: One of the body's defenses in a cold is to wash out the sinuses with fluids. This is why you develop a runny nose. A moisturizer will often help in this process. It is important not to reduce the nose's secretions because it helps to prevent sinus infections. Antihistamines which are contained in many cold medications dry secretions and thus may not be the drug of choice.

Decongestant and No Other Medications:

Sudafed PE Nasal Decongestant (The PE formulation contains Phenylephrine)

Decongestant and Pain Medication:

Advil Cold & Sinus (has Ibuprofen--similar to aspirin)
Sinutab Sinus (acetaminophen)
Sudafed Cold & Sinus (acetaminophen)
Tylenol Sinus Non-Drowsy (acetaminophen)

Decongestant and Moisturizer:

Robitussin PE* (100 mg Guaifenesin per teaspoon)
Sudafed Non-Drying Sinus* (200 mg Guaifenesin)

Decongestant, Cough Suppressant and Pain Medication (Acetaminophen)

Sudafed Cold & Cough
Sudafed Severe Cold Formula
Tylenol Cold
Vicks Dayquil Cold/Flu Relief*
Theraflu - Non-Drowsy Formula  Flu, Cold and Cough

Moisturizer and Cough Suppressant:

Robitussin DM*

Moisturizer:

Robitussin* (100 mg Guaifenesin per teaspoon)

Decongestant Nose Sprays:

Afrin
Dristan
Neosynephrine
Triaminic Infant
Vicks Sinex

Decongestant and Cough Suppressant

Robitussin Pediatric Cough & Cold*
Vicks 44D Cough & Head Congestion Relief*

Decongestant, Cough Suppressant, Pain Medication (Acetaminophen) and Moisturizer.

Sudafed Cold & Cough

* Denotes Elixir or Liquid Medication

NOTE: Many "Cold" & "Sinus" medications contain acetaminophen. If used together, liver damage can occur from an over dosage.