Antibiotic for sinusitis intramuscularly

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Antibiotics for acute and chronic sinusitis

Therapeutic measures for sinusitis are aimed at eliminating inflammation and restoring the outflow of mucopurulent contents from the maxillary cavity.

Table of contents:

Treatment of sinusitis with antibiotics allows you to destroy the cause of the disease and prevent complications.

Why is sinusitis treated with antibiotics?

One of the main stages of treating sinusitis is antibiotic therapy. Antibacterial drugs are used to treat all types of sinusitis: bacterial, viral, and fungal.

For sinusitis caused by bacteria, antibiotics are used to suppress the activity of pathogenic agents.

Acute viral sinusitis can be complicated by the addition of a bacterial infection, which creates all the conditions for the transition from the acute form to the chronic stage of the disease with a particularly persistent course.

For sinusitis caused by a fungal infection, medications are prescribed containing a unique antibiotic, fusafungin, which has a wide spectrum of action, affecting almost all pathogenic bacterial microflora - cocci, bacilli, anaerobic bacteria, molds.

Antibiotics for sinusitis are used topically in the form of sprays and nasal drops, as well as in general treatment in tablets, injections intravenously or intramuscularly.

Treatment of sinusitis with antibiotics is only one type of treatment for this disease. We also suggest that you familiarize yourself with the method of laser surgery in the article Laser surgery: treatment of sinusitis.

Local use of antibiotics for sinusitis

Local treatment of sinusitis with antibiotics is used as the preferred option for the treatment of acute sinusitis and as an additional remedy in the complex of general therapy. Isofra, Polydex, and Bioparox sprays are considered modern means of local treatment of sinusitis.

Isofra spray

The drug contains framycetin, which belongs to the aminoglycoside series of antibiotics. Framycetin effectively inhibits the bacterial flora of the nasopharynx and respiratory tract (instructions for Isofra).

Like other aminoglycosides, framycetin exhibits an ototoxic effect at high concentrations, causing hearing loss.

However, when used topically, the drug does not accumulate in the body and is not able to adversely affect hearing.

Polydex spray with phenylephrine

The spray contains the antibiotics neomycin and polymyxin, which belong to different groups of antibiotics. The spectrum of action of these compounds covers all possible infections of the paranasal sinuses.

The spray contains the anti-inflammatory glucocorticoid drug dexamethasone and the vasoconstrictor phenylephrine.

Aerosol bioparox

The main active ingredient is the antibiotic fusafungin, which can suppress pathogenic aerobic and anaerobic bacteria, mycoplasmas, and fungi.

Fusafungin also exhibits anti-inflammatory properties, which increases its effectiveness against sinusitis.

How not to use sprays

  • Do not turn the spray into drops and try to put it in your nose. It's so hard to get the dosage right.
  • The spray contains an antibiotic; it should not be used for longer than 10 days and should not be used unsupervised from time to time.
  • If there is no result, the dosage cannot be increased. The right thing to do is to visit the doctor, he will give you another prescription.
  • Do not use nasal spray.

Antibiotic nasal drops for sinusitis

For sinusitis, it is recommended to use Sinuforte nasal drops in combination with antibiotic treatment. Sinuforte is of plant origin, contains an extract of cyclamen, and has a pronounced anti-edematous effect.

On the forums there are reviews about the effective treatment of sinusitis in children with the antibiotic dioxidine. The drug should not be used for instillation into the nose of children; the use of dioxidine, as indicated in the instructions, is contraindicated under the age of 18 years.

General use of antibiotics for sinusitis

Antibiotic therapy is the first-line treatment for sinusitis. The goal of treatment is to destroy pathogenic microflora and restore the functionality of the mucosa.

The sensitivity of sinusitis pathogens differs in different regions.

As a result of long-term use of antibiotics, a large number of pneumococcal forms resistant to benzylpenicillin and macrolides have now emerged.

Resistance of Haemophilus influenzae to aminopinicillin antibiotics is also observed. A high level of immunity is observed in Haemophilus influenzae and pneumococci to the antibiotic co-tricmoxazole.

The best choice of antibiotics for sinusitis caused by streptococcus and Haemophilus influenzae are aminopenicillins and cephalosporins. Good sensitivity is noted to amoxicillin, ampicillin, benzylpenicillin, cefuroxime.

Treatment of sinusitis with folk remedies, as an addition to the main treatment, in the article Treatment of sinusitis at home

How to choose an antibiotic to treat sinusitis

To identify the causative agent of sinusitis, it is necessary to perform a diagnostic puncture.

For a number of reasons this is not always possible. The procedure is painful and fearful for many.

The choice of antibiotic must be made empirically, based on the prevalence of pathogens in the region and their sensitivity to antibacterial drugs.

Acute sinusitis

The drug of choice for the treatment of acute sinusitis is amoxicillin from the aminopenicillin series.

Amoxicillin has good bioavailability, up to 93% of the drug is absorbed when taken orally.

Amoxicillin tablets taste good and can be chewed or washed down with water; the antibiotic is prescribed for the treatment of sinusitis for both adults and children.

The drug is considered relatively safe for the gastrointestinal tract. It does not accumulate in high concentrations in the intestines and practically does not cause dysbiosis.

If treatment fails, second generation cephalosporins are prescribed. Preference is given to cefuroxime or ceftriaxone.

The drugs are intended for intramuscular or intravenous administration. Ceftriaxone injections are given once every 24 hours for three days in a row. When treating acute sinusitis with antibiotics, injections are often preferable because the drug immediately enters the bloodstream.

Among the cephalosporins, the third generation antibiotic ceftibuten is highly effective. It is part of the drug Zedex and is sold in capsules and powder for the preparation of suspensions. Adults take Cedex in the form of tablets, children - in the form of a suspension.

The advantages of the drug include the ability to accumulate in high concentrations at the site of infection. Cedex tablets or suspension are taken once a day, which is an undeniable advantage of the drug.

For acute sinusitis, fluoroquinolone antibiotics are used, which have a broad spectrum of action and high activity against Haemophilus influenza and streptococci. The drugs of choice are levofloxacin and moxifloxacin.

Levofloxacin has optimal characteristics for the treatment of severe forms of acute sinusitis.

Levofloxacin tablets are well tolerated by patients and do not cause intestinal complications. Levofloxacin is used for allergies to aminopenicillin antibiotics.

Moxifloxacin is taken orally in tablets. The antibiotic is indicated for bacterial sinusitis and is used to treat sinusitis in adults.

Moxifloxacin is not prescribed to children under 18 years of age due to contraindications.

For allergies to the aminopenicillin series, macrolides are prescribed. They are classified as second-line antibiotics because they are less effective in treating acute sinusitis. Of the macrolides, preference is given to roxithromycin, azithromycin, and clarithromycin.

Doxycycline is used from the tetracycline series. It is prescribed for allergies to aminopennicillin antibiotics for adults and children over 8 years of age.

Treatment regimen for mild sinusitis

For acute viral sinusitis, antibiotics are not prescribed in the first 10 days of treatment.

As a replacement, Echinacea compositum C can be prescribed. If there is no result, antibiotic therapy is resorted to.

Moderate course

The main drugs are amoxicillin and levofloxacin. Alternative drugs are cefaclor, cefuroxime, azithromycin, clarithromycin, roxithromycin, doxycycline.

Severe form

Medicines are administered parenterally, bypassing the gastrointestinal tract.

Preference is given to combination drugs amoxicillin + clavulonic acid or ampicillin + sulbactam.

If you are intolerant to aminopenicillins, the choice is cefuroxime, cefutaxime, ceftriaxone, cefoperazone, ciprofloxacin, chloramphenicol.

Chronic sinusitis

When treating chronic sinusitis in adults, amoxicillin, cefotaxime, roxithromycin or other broad-spectrum antibiotics are prescribed from the first days.

A selective drug is prescribed after obtaining the results of bacterial culture and determining the nature of the pathogen and its sensitivity to antibiotics.

In addition to taking antibiotics in tablets and parenteral administration of drugs, for chronic sinusitis, the Proetz method of moving drugs or the “cuckoo” method is used in treatment. The medicinal composition includes broad-spectrum antibiotics.

Antibiotics are also included in the composition during treatment with the YAMIK catheter. The YAMIK device can cure sinusitis in several procedures; antibiotics and anti-inflammatory drugs included in the complex for washing sinuses completely suppress the activity of pathogenic flora.

Treatment of sinusitis in children with antibiotics

For acute sinusitis, children are prescribed antibiotic treatment in a lower dosage than adults. The drug of first choice is usually amoxicillin tablets.

Read more about the treatment and prevention of sinusitis in a child in the article Treatment, symptoms, prevention of sinusitis in children.

If there is no effect of treatment, the dose is increased or replaced with a complex drug amoxicillin + clavulanic acid. The drug is well absorbed in the form of a suspension or dissolved tablets, and is approved for use by young children.

Locally, children over 2.5 years of age are prescribed Bioparox aerosol, which contains the antibiotic fusafungine.

In case of severe sinusitis in children, the antibiotic ceftriaxone is added to the treatment complex.

The drug is intended for intravenous and intramuscular administration, has a wide spectrum of action, and is approved for use by children from an early age.

The non-surgical YAMIK method is used to treat children; sometimes 4 procedures are enough for the child’s condition to normalize.

The difficulty of treating sinusitis with antibiotics lies in the prevalence of types of pathogens that are resistant to antibiotics, and the difficulty in determining the bacterial, viral or fungal origin of inflammation.

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Antibiotics for sinusitis. Which drug to choose for a serious sinus disease?

Sinusitis is a type of acute sinusitis - inflammation of the paranasal sinuses. With sinusitis, the large maxillary sinuses, called the maxillary sinuses, are affected. The English physician Highmore first described the symptoms of acute sinusitis back in the 15th century and retained his name in history.

Before you continue reading: If you are looking for an effective method of getting rid of a runny nose, pharyngitis, tonsillitis, bronchitis or colds, then be sure to look at this section of the site after reading this article. This information has helped so many people, we hope it will help you too! So, now back to the article.

The name of the disease, noticed by an Englishman more than 500 years ago, is heard, alas, too often. About 1 in 10 adults experiences sinusitis. In pediatrics, inflammation of the maxillary sinuses is a common complication of a respiratory viral infection: 6–13% of acute respiratory viral infections result in bacterial infection and sinusitis.

According to statistics published by American experts, about 14% of adults experience at least one episode of acute sinusitis per year. And let’s complete our immersion in the world of numbers with information from the field of pharmaceuticals. Sinusitis occupies an honorable fifth place among diagnoses for which antibiotics are prescribed.

The target is pathogenic bacteria!

So, we have already figured out that sinusitis is an inflammatory process. This means that it is caused by pathogenic microorganisms. In healthy people, the maxillary sinuses are sterile. However, as a result of obstruction of the drainage paths, disruption of the activity of the ciliated epithelium and changes in the quality and quantity of mucus, the maxillary sinuses are colonized by pathogenic bacteria. The main causative agents of the inflammatory process in the maxillary sinuses include:

  • Staphylococci, including S.pyogenes, S.aureus (Staphylococcus aureus), S.pneumonia, coagulase-negative staphylococcus;
  • streptococci, including alpha-hemolytic streptococcus;
  • fusobacteria;
  • Moraxella;
  • corynebacteria;
  • peptostreptococci;
  • Haemophilus influenzae.

I would like to note that in approximately 30% of cases of sinusitis, the infection is of mixed origin, that is, the number of pathogens is more than one.

Any inflammatory process accompanied by bacterial infection requires antibacterial therapy. No matter how much we would like, the body is not able to cope with the onslaught of pathogenic microorganisms on its own, and antibiotics are essential drugs for sinusitis.

Let's try to figure out what antibacterial drugs are prescribed for inflammation of the maxillary sinuses and when one or another drug is preferred.

What antibiotics should I take for sinusitis? General selection principles

When choosing an antibacterial agent, doctors, as a rule, are guided by general principles that are regulated in standard treatment protocols.

And acute sinusitis is no exception. What antibiotics are taken for sinusitis? Antibacterial agents prescribed for acute sinusitis are divided into three large groups.

First line drugs.

This category includes drugs that are used primarily. It is these antibiotics that have maximum effectiveness for sinusitis and are used for treatment as the drugs of choice:

Second line drugs.

These agents are used to treat patients who live in environments with high rates of resistant microorganisms. In addition, reserve group drugs are used if first-line antibiotics do not give the desired result after 3–7 days of treatment for sinusitis. Second-line antibiotics include:

  • Amoxicillin with clavulanic acid;
  • cephalosporin antibiotics of the second and third generation;
  • fluoroquinolones.

Patients with hospital-acquired sinusitis are a special category of patients whose treatment will require intravenous administration of antibacterial drugs. Among the most effective injection drugs we note:

To understand the specifics of using antibiotics for sinusitis, you will have to consider each drug in more detail. And we will start with the most popular antibacterial agent of the penicillin series - Amoxicillin.

Are penicillins the enemies of sinusitis?

Penicillins are deservedly among the most effective and safe antibacterial agents. They can be prescribed to children, from infancy, to adults and elderly patients.

In addition, penicillins are widely used in obstetrics. Drugs of the benzylpenicillin group belong to category B, conditionally permitted during pregnancy and lactation. The experience of prescribing these drugs in pregnant women proves the high safety and excellent tolerability of the drugs. Penicillins are the drugs of choice for many infectious diseases in pregnant women.

However, we must not forget that many strains of pathogens produce beta-lactamases, which destroy the beta-lactam ring of the antibiotic. The danger of prescribing penicillins for acute sinusitis is due to the fact that among the causative agents of the disease there are strains that produce beta-lactamases. That is, when treating sinusitis with unprotected antibiotics of the penicillin group, there is a hypothetical probability of the drug being ineffective.

Does Amoxicillin help with sinusitis?

The effect of Amoxicillin, one of the most famous antibiotics from the group of semisynthetic penicillins, for sinusitis was studied by American scientists. The randomized, placebo-controlled trial included 166 adults with acute bacterial sinusitis. Of this group, 85 lucky people received Amoxicillin, and 81 people received a placebo. The course of treatment was 10 days. Who do you think is luckier?

The results of the experiment were quite unexpected. On the third day of therapy, there was no difference in well-being between the two parallel groups. On the seventh day of the study, volunteers taking antibiotics reported feeling better. These data were confirmed laboratory. However, the story did not end there.

On the tenth day of the experiment, 80% of patients from both groups reported a significant improvement in their health or complete recovery. The results of a study on the comparative effectiveness of the antibacterial agent Amoxicillin and placebo in the treatment of sinusitis showed that the effect of unprotected penicillin is practically no different from the effect of a pacifier.

When prescribing Amoxicillin, one should not forget that about 64% of S.pneumoniae staphylococcus strains are resistant to penicillin. And Staphylococcus aureus is “famous” for its resistance to unprotected antibiotics of this group, reaching 90% and above. According to American scientists, the resistance of Haemophilus influenzae to Amoxicillin ranges from 27–43%.

And yet, despite all this very contradictory information, Amoxicillin (or Flemoxin) until recently was used to treat uncomplicated forms of sinusitis as the antibiotic of choice, especially for children. Moreover, the drug was recommended as one of the three first-line antibiotics, that is, those drugs that are prescribed first.

Let us recall that the activity of Amoxicillin extends to strains of streptococcus pneumoniae, Haemophilus influenzae and anaerobic bacteria. The drug has a moderate effect on moraxella and is not effective against infection with bacteria that produce beta-lactamase.

According to information published by American scientists, the effectiveness of treatment of sinusitis with high doses of Amoxicillin is 80–90%. The high safety of penicillin antibiotics allows Amoxicillin to be widely used for sinusitis in children.

Dosages of Amoxicillin for uncomplicated sinusitis are quite impressive and are almost twice as high as the standard dose. Experts recommend prescribing about 80–90 mg of Amoxicillin per kilogram of body weight per day. The daily dose must be divided into two doses. It is better to take the drug after meals. The duration of treatment is usually 5–7 days.

Macrolides - antibiotics for sinusitis No. 1

The antibiotics of choice for the treatment of sinusitis include drugs from the macrolide group. Macrolides do not contain a lactam ring, so the notorious penicillinase is absolutely powerless in relation to these drugs. This means that macrolides also effectively act on strains of microorganisms that produce beta-lactamases.

Macrolides, compared to penicillins, exhibit much greater activity against the bacterium Moraxella catarrhalis (Moraxella).

I would like to add that macrolides are the drugs of choice for allergies to penicillin antibiotics.

Among the drugs that most widely cover the spectrum of potential pathogens of acute sinusitis, Clarithromycin and Azithromycin are recognized as the most effective and safe. Let's try to understand the advantages and disadvantages of each of these antibiotics.

This drug belongs to the second generation macrolides and has high activity against all microorganisms, without exception, associated with acute and chronic sinusitis.

For sinusitis, 500 mg to 750 mg of Clarithromycin are prescribed twice a day, and the pediatric dosage of the antibiotic is 7.5 mg per kilogram of body weight per day. It is better to use the medicine at regular intervals.

The course of treatment is from 7 to 10 days. The final decision on the dosage and duration of therapy is made by the attending physician.

Azithromycin is a 15-membered macrolide. The main difference between an antibiotic and other drugs is its long half-life. Thanks to this property, Azithromycin has a completely unique course of treatment.

For the treatment of sinusitis in adults, Azithromycin is used in a dosage of 500 mg once on the first day of therapy, after which it is sufficient to drink 250 mg of the antibiotic once a day for four days. Thus, the course of treatment for acute sinusitis is only five days.

Second-line antibiotics: complicated and purulent sinusitis

As we have already mentioned, second-line drugs are prescribed if the causative agents of sinusitis are resistant to Amoxicillin and macrolides. In this case, it is recommended to culture the material to determine sensitivity to antibiotics, but empirical prescription of drugs is also allowed.

When can a doctor suspect a resistant infection and what symptoms indicate high resistance of pathogenic microorganisms?

Infection with resistant strains of bacteria is likely if the patient does not feel improvement within the first two to three days of first-line antibiotic therapy. That is, if after three days of taking Amoxicillin or Clarithromycin you still have symptoms of intoxication - fever, weakness and headache - you must immediately notify your doctor. Most likely you will have to select an alternative antibiotic.

Second-line antibacterial drugs that are indicated for the treatment of sinusitis include protected penicillins, cephalosporins and fluoroquinolones. Let's take a closer look at these groups.

Protect Amoxicillin!

We have already said that a particular problem in selecting an antibiotic for the treatment of sinusitis is the presence of beta-lactamase-producing strains among the causative agents of the disease. Therefore, the ideal treatment for acute sinusitis includes a procedure such as sowing the contents of the maxillary sinuses and determining sensitivity to antibiotics. This test allows you to identify the pathogen and select an antibacterial agent that is active against the microorganism.

However, not everything is as simple as it seems. After all, to obtain the material it is necessary to perform a puncture, and this is a very serious procedure. Therefore, doctors, as a rule, have to act almost at random, and treatment is prescribed empirically. The doctor’s main task at this stage is to select exactly the antibiotic that will work. In the vast majority of cases, ENT doctors avoid prescribing Amoxicillin and go straight to second-line drugs.

Unprotected penicillins are being replaced by complexes with clavulanic acid. They have all the advantages of Amoxicillin and do not have its main disadvantage - vulnerability to penicillinase.

The most popular protected penicillins, which are often used for sinusitis, include tablets Augmentin, Amoxiclav, Flemoklav and other antibacterial drugs. Experts say that Amoxicillin and clavulanic acid complexes are effective in more than 90% of cases of sinusitis.

For sinusitis, it is recommended to take protected Amoxicillin twice a day. The final dosage and course of treatment is determined by the attending physician.

Cephalosporin antibiotics in tablets: alternative help for sinusitis

For sinusitis, second- and third-generation antibiotics from the group of cephalosporins are used as second-line tablets. These include oral forms:

Cefuroxime is a second generation cephalosporin. Cefuroxime tablets are produced:

  • the German company Sandoz called Cefuroxime-Sandoz;
  • Glaxo Corporation (Zinnat);
  • Medokemi company (Cyprus) produces antibiotic tablets Aksef.

Cefuroxime has a pronounced effect on the vast majority of pathogens of acute sinusitis, including strains that produce beta-lactamase. The standard dosage is 250 mg cefuroxime twice daily for 7–10 days.

Cefpodoxime is a third generation cephalosporin. The main difference between these antibiotics and second-generation drugs is their high activity against gram-negative flora. In addition, injectable drugs of this group have very high bioavailability, while oral drugs, on the contrary, are poorly absorbed in the intestine.

One of the most common drugs containing cefpodoxime is Jordanian Cefodox, which is available in the form of tablets of 100 and 200 mg, as well as a children's suspension in several dosages. In addition, Indian Cepodem is registered in Russia. Note that most doctors prefer to prescribe the Jordanian analogue.

Cefodox has a fairly low level of absorption - only about 52%. Therefore, when prescribing this tablet antibiotic for sinusitis, the doctor must take into account the low bioavailability of the drug.

The dosage of cefpodoxime for acute sinusitis is 200 mg twice daily for 7–10 days.

The drug also belongs to the third generation semisynthetic cephalosporins. I would like to draw your attention to the fact that Cefixime is inactive against many gram-positive bacteria. Thus, most strains of Staphylococcus aureus are resistant to this antibiotic.

Just like Cefpodoxime, Cefixime is poorly absorbed from the gastrointestinal tract: the bioavailability of the drug is only 40-50%.

As a common analogue of Cefixime, we will name the antibiotic Suprax, which is also available in a dispersible form, which has higher bioavailability. In addition, in Russian pharmacies you can find the Indian analogue Ixim and the medicine produced in Macedonia Pancef.

American experts recommend not using third-generation cephalosporins as monotherapy for the treatment of sinusitis due to the fairly high probability of bacterial resistance to these antibiotics. The combination of Cefixime and Cefpodoxime is capable of covering almost the entire spectrum of pathogenic bacteria associated with sinusitis.

Thus, one of the most effective alternatives to protected penicillins is the use of two cephalosporins at once - Cefpodoxime and Cefixime.

According to experts, the effectiveness of these antibiotics for acute purulent sinusitis is more than 90%.

Well-known and effective fluoroquinolone antibacterial drugs that are used to treat acute and chronic sinusitis include:

Note that fluoroquinolones are contraindicated for use in children and adolescents. This is associated with the risk of developing irreversible changes in the structure of cartilage tissue. However, for health reasons, fluoroquinolones are still used in childhood.

When are antibiotic injections used for sinusitis?

We have come to a description of one of the most pressing problems faced by patients suffering from acute sinusitis. The fact is that domestic ENT doctors, in their undoubtedly noble desire to quickly relieve the patient of the symptoms of sinusitis, vying with each other to prescribe injectable drugs.

Doctors eloquently convince their patients of the urgent need for parenteral treatment as the only possible path to healing. Exhausted by the lack of a breath of fresh air, patients, of course, believe the all-powerful man in a white coat and obediently follow to the pharmacy for a set of syringes, bottles of antibiotics and lidocaine.

This is followed by seven or even ten days of procedures, and then treatment of the consequences of injection therapy. Of course, after such therapy the disease recedes. However, are antibiotic injections really necessary for sinusitis?

According to leading experts in the field of otorhinolaryngology, parenteral use of antibiotics is indicated for patients with hospital-acquired acute sinusitis. In such cases, the infection is usually caused by highly resistant gram-negative microorganisms. The drugs of choice include aminoglycoside antibiotics. To correctly select an antibacterial agent, it is recommended to inoculate the culture and determine the sensitivity of the inoculated bacteria.

Let us consider the dosages and spectrum of activity of parenteral antibiotics in more detail.

The most effective drugs include Tobramycin and Gentamicin. It is worth noting that both antibiotics are not active against streptococci and other anaerobic bacteria. Moraxella and Haemophilus influenzae, on the contrary, are highly sensitive to the action of aminoglycosides.

The dosage of Tobramycin and Gentamicin is calculated depending on the patient’s weight: per kilogram of weight there is 1.7 mg of antibiotic. Frequency of application: twice a day.

It is worth noting that the use of aminoglycosides is associated with a high risk of side effects. One of the most dangerous adverse events associated with treatment with these drugs is damage to the auditory branches, resulting in irreversible deafness. Therefore, Tobramycin and Gentamicin are used exclusively under the supervision of a physician.

Second generation cephalosporins.

Cefuroxime is practically the only second-generation parenteral cephalosporin antibiotic used for the treatment of acute sinusitis. Injectable medicines containing cefuroxime as an active ingredient are lyophilized powder that must be diluted before use. The most commonly used solvents are water for injection and 2% lidocaine solution.

To treat sinusitis, 1 gram of Cefuroxime is prescribed every eight hours. One of the most famous drugs in Russia containing cefuroxime is Zinacef.

Third generation cephalosporins.

Injectable agents in this group include Cefotaxime, Ceftazidime and, of course, the well-known Ceftriaxone. Third generation cephalosporins are highly active against gram-negative microorganisms.

The recommended dosage of antibiotics for the treatment of severe sinusitis is:

  • Cefotaxime is prescribed 2 grams every 4–6 hours;
  • Ceftriaxone - 2 grams per day, divided into two doses;
  • Ceftazidime is used at a dose of 2 grams every 8 hours.

Severe cases of acute purulent nosocomial sinusitis require the use of potent broad-spectrum antibiotics - carbapenems. These drugs are used exclusively in a hospital under the supervision of specialists.

Antibiotic drops for sinusitis: necessary or useless?

Many patients ask the same question: do antibiotic nasal drops and sprays help with sinusitis? Is it worth using them? And is it possible to get by with local remedies without resorting to oral, that is, tablet drugs? It's time to clear all doubts.

If you are diagnosed with sinusitis, you need to be prepared for the fact that it is almost impossible to cure without antibiotics - a bacterial infection simply requires adequate therapy. Local preparations - sprays and nasal drops - containing an antibacterial active substance are not able to penetrate the maxillary sinuses. Consequently, their use is practically meaningless. So, let us emphasize: for acute and chronic sinusitis, nasal drops or antibiotic sprays are simply ineffective.

The only way out in this situation is oral, and in severe cases, parenteral (injection) antibacterial agents.

Prescribing antibiotics is the doctor’s task

I would like to draw your attention to the fact that the selection of the correct antibacterial drug is the prerogative of the ENT doctor. We must not forget that among the causative agents of acute sinusitis there are also antibiotic-resistant strains that are insensitive to penicillins and cephalosporins. Therefore, self-prescription of an antibiotic for sinusitis may result in serious complications rather than the desired recovery.

Remember that at the first signs of sinusitis you need urgent consultation with a specialist and immediate antibacterial treatment.

The article above and comments written by readers are for informational purposes only and do not encourage self-medication. Consult a specialist regarding your own symptoms and illnesses. When taking any medicine, you should always use the instructions that come with the medicine and your doctor's advice as a guide.

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Antibiotics for sinusitis: TOP effective and inexpensive

Sinusitis is an inflammation of the maxillary sinuses, which can be of a bacterial, allergic, traumatic, or viral nature. It usually develops against the background of colds, acute respiratory viral infections or influenza, but can act as a separate pathology.

If sinusitis is bacterial in nature, the patient is advised to use antimicrobial drugs. Without their use, the purulent exudate located in the sinuses can “break through”, affecting the human brain. The consequence of this may be encephalitis or meningitis.

When are antibacterial drugs necessary?

Antibiotics are extremely necessary if sinusitis is accompanied by the release of purulent contents of the sinuses from the nasal passages. The group and dosage of the drug can be prescribed exclusively by an otolaryngologist, based on the clinical manifestations of the disease and its severity.

Before using antibiotics, two diagnostic tests are required:

  1. Bacterial inoculation on a nutrient medium, with the help of which the nature of the disease is accurately established, as well as its causative agent (the type of pathogenic microorganisms that caused the development of purulent sinusitis).
  2. Antibioticogram. Such a clinical study determines the sensitivity of a particular type of pathogenic microorganism to certain antibacterial drugs. Thanks to its implementation, the doctor can prescribe exactly the medicine that will give maximum results in the fight against purulent sinusitis.

So, when are antibiotics necessary, and what might be the indications for their use? They are used if sinusitis is accompanied by the following symptoms:

  • pain in the area of ​​the frontal lobes and orbits;
  • pressing sensations in the nose and forehead;
  • a significant increase in body temperature (with acute purulent sinusitis, since chronic sinusitis almost never causes fever, except low-grade fever);
  • copious discharge of purulent exudate;
  • difficulty breathing through the nose, especially at night;
  • intense headaches, which are difficult to get rid of even with the help of potent painkillers;
  • discomfort, pain and pressing sensations in the nose and forehead when bending sideways or to the side.

If therapy is not started in a timely manner, the disease can not only become chronic, but also affect the brain. The consequences of such complications can be unpredictable.

Antibiotic therapy is usually prescribed a week after the onset of the pathological process. It is necessary if nasal rinsing and rinsing, as well as therapeutic inhalations, have not produced any results. Only the attending physician can prescribe an antibacterial drug - you should not self-medicate, since antimicrobial drugs, if used uncontrolled, can cause serious side effects, including angioedema and anaphylactic shock.

What antibiotics will help?

It is impossible to say unambiguously which antimicrobial drugs will be effective in each specific case. It all depends on the results of the antibiogram and bacterial culture for pathogenic microflora. The doctor will prescribe only the antibacterial drug to which the pathogen is most sensitive and has not yet developed resistance. The risk of adverse reactions is also taken into account.

Often, for the treatment of purulent sinusitis, patients are prescribed the use of the following groups of antibiotics:

  1. Penicillin. It is this group of antibacterial drugs that is most often used to treat mild sinusitis. This is due to the low risk of side effects from their use. However, if the disease is severe, such medications will not be effective.
  2. Macrolides. Prescribed in case of intolerance by the patient's body to antimicrobial drugs of the penicillin group.
  3. Fluoroquinols. The advantage of this series of antibacterial drugs is that most pathogenic microorganisms have not yet developed resistance to them. However, due to the fact that such substances are not synthesized in nature, but are manufactured exclusively in the laboratory, and are strictly contraindicated for young children.
  4. Cephalosporins. Such antibiotics are prescribed in extremely difficult situations - if sinusitis threatens to “break through” and affect the brain, or become chronic. They can also be prescribed if other antibacterial agents are ineffective.

Self-medication with antibiotics is dangerous because many patients begin therapy without making sure that they are not allergic to the chosen drug. Allergy tests are a mandatory measure that are always carried out by a doctor before starting treatment for purulent sinusitis in a patient.

List of antibiotics for sinusitis

The choice of antibiotics for the treatment of sinusitis depends on several factors:

  • individual characteristics of the patient’s body;
  • presence of concomitant diseases;
  • the risk of developing allergies or complications after a course of antibiotic therapy (intestinal dysbiosis, etc.).

The selection of the drug is also carried out taking into account the results of a study of a smear of nasal secretions using the Gram staining method.

As a rule, therapy for sinusitis begins with relatively mild penicillin antibiotics. They have a bactericidal effect, achieved by blocking the synthesis of cellular elements of pathogenic microorganisms that cause sinusitis. This leads to the death of pathogenic microflora, resulting in recovery.

List of drugs based on the penicillin series:

  1. Ampicillin sulbactams: Sulbacin, Sultamicillin, Ampisid, etc.
  2. Amoxicillin clavulanates: Amoxiclav, Augmentin, Flemoclav, etc.

Use should be carried out under the close supervision of a physician, especially if treatment is prescribed for a small child. Although penicillins are considered one of the safest antibacterial groups, it never hurts to be safe.

Treatment with macrolides

Macrolides are given special preference because they rank first among antibacterial drugs in terms of their safety. They rarely cause side effects, which explains their popularity and relevance.

These drugs do not block the cell membranes of pathogenic bacteria, but have a bacteriostatic effect, that is, they prevent further proliferation of pathogenic microflora. These properties are especially useful for chronic purulent sinusitis.

Macrolide drugs can be:

  • 14-membered: Erythromycin, Clarithromycin, etc.;
  • 15-membered: the drug Azithromycin and its analogues (azalides) (Sumamed, Azitrus, Zitrolide, etc.);
  • 16-membered: Midecamycin, Spiramycin, Josamycin.

Use of cephalosporins

Cephalosporins have been used for the treatment of sinusitis for a long time, and quite successfully. In addition, microorganisms rarely develop resistance to this group of antibiotics, which is also considered their organizational advantage.

According to generally accepted co-assification, cephalosporins are:

  • 1st generation – Cefazolin, Ceflexin and their analogues;
  • 2 generations – Cefuroxime, Mefoxin, Zinacef, etc.;
  • 3 generations – Cefixime, Ceftriaxone, etc.;
  • 4 generations - Cefpirom, Cefepime, etc.;
  • 5th generation – Ceftolozane, Zaftera, etc.

Use of fluoroquinolones

Fluoroquinolones are synthetic substances that, in their structure and properties, are very different from other groups of antibacterial drugs. When treating sinusitis, these drugs are used only in extreme cases. During pregnancy and lactation they are strictly contraindicated, as they can cause serious harm to the health of the child.

Fluoroquinolones are divided into 4 generations (the list number reflects the generation number of the antibiotics in this series):

  1. Tarivid, Unikpev, Tarivid.
  2. Ciprofloxacin, Norfloxacin, Cifrinol, etc.
  3. Levofloxacin, Ecotsifol, Normax.
  4. Moxifloxacin, Avelox, Gemifloxacin, etc.

An antibacterial drug is prescribed only after collecting the results of a bacteriological nasal smear and an antibioticogram. Within two days after the start of therapy, the first improvement should occur. If this does not happen, the drug is urgently replaced with another.

Systemic antibiotics for sinusitis

Indications for oral or parenteral use of antibacterial drugs in the treatment of purulent sinusitis are:

  • development of intoxication syndrome;
  • prolonged course of the disease;
  • acute catarrhal sinusitis, accompanied by pronounced symptoms;
  • rapid progression of the disease in an acute form;
  • the presence of copious mucous or purulent discharge with severe nasal congestion;
  • severe pain in the maxillary sinuses, eyes, frontal lobes, cheekbones;
  • development of complications of sinusitis, expressed through otitis, periostitis of the upper segment of the jaw, addition of a secondary infection, etc.

Oral and parenteral administration of antibiotics often causes complications in the form of allergic reactions and intestinal dysbiosis. For this reason, the patient must be prescribed probiotics in parallel.

Injectable drugs

The most optimal option for antibacterial agents for sinusitis, dispensed in the form of solutions for intramuscular injections, is considered to be the cephalosporin group. If we talk about specific medications, the drugs Cefazolin and Ceftriaxone are often used for this purpose. Despite the similarity in the principle of influencing pathogenic microflora, these agents also have some differences.

  1. Ceftriaxone is a dry powder, dispensed in ampoules, and intended for the preparation of a solution for intramuscular or intravenous administration. It is used for severe sinusitis and has a powerful bactericidal effect. The powder is diluted with water for injection or lidocaine solution (painkiller). This medicine is extremely necessary in the presence of purulent contents of the maxillary sinuses. Progress is noted after 2-3 injections.
  2. Cefazolin is also available in powder form for the preparation of an injection solution. Diluted with sodium chloride or water for injection. It is used for the treatment of acute sinusitis without pronounced complications. A significant drawback of the drug is its ability to cause severe allergic reactions, so it is used with extreme caution to treat young children.

The main difference between Ceftriaxone and Cefazolin is that this drug has a more powerful effect. Both injections are very painful, but Ceftriaxone still causes a more intense pain syndrome, so the powder is diluted with lidocaine.

Local treatment

Systemic administration of antibacterial drugs is often carried out in combination with special solutions for treating the nasal cavity. Here is a list of the most effective drugs.

  1. Polydexa. This antibiotic is used extremely rarely to treat the nasal passages because it can cause serious side effects. It contains neomycin and polymyxin B. However, the spray gives good results in the treatment of sinusitis and purulent sinusitis, and also prevents the development of complications of the disease and the addition of a secondary infection.
  2. Biparox is an antibacterial drug for topical use in the treatment of sinusitis. Dispensed in the form of an aerosol with a dispenser for spraying the medicine into the nasal passages. The active substance is fusafungine. This polypeptide antibiotic copes well with various pathogenic microflora: pathogenic bacteria, fungi, mycoplasma, etc. At the same time, it has an anti-inflammatory effect.
  3. Isofra is another highly effective antibacterial agent for combating acute manifestations of sinusitis. The active substance is the aminoglycoside framycetin. The spray copes well with inflammatory processes occurring in the paranasal sinuses.

Another widely used aminoglycoside antibiotic intended for topical use is Taizomed. The drug contains the active component torbamycin. This is a broad-spectrum drug that has a powerful antimicrobial effect.

Contraindications and side effects

Antibiotics should not be used to treat sinusitis if:

  • presence of allergic reactions;
  • pregnancy (without a doctor’s prescription) (see first signs of pregnancy);
  • renal failure (drugs Flemoxin, Sumamed, Zitrolide);
  • liver dysfunction (Amoxiclav).

Other contraindications to the treatment of sinusitis with antimicrobial drugs are:

  • lymphocytic leukemia;
  • Infectious mononucleosis;
  • children under 12 years of age;
  • impaired blood clotting;
  • tendency to open bleeding.

If used incorrectly or overdosed with antibacterial drugs, side effects may occur in the form of nausea, vomiting, slight rise in body temperature, skin flushing, itching, urticaria, headaches, dizziness, stool disorders, and sleep problems. Children may develop conjunctivitis, their general health may deteriorate, and migraines may occur. To avoid this, take the medications prescribed by your doctor correctly!

Are there antibiotics for children?

It is not antibiotics that are “adult” or “children”, but the dosage of a particular drug. Treatment of sinusitis in young patients is mainly based on the local use of antimicrobial agents. Basically, these are drops or sprays.

There are other “children’s” forms of antibiotics:

  • suspensions for oral administration;
  • tablets (from 12 years and older);
  • injections.

Only an ENT specialist, a family doctor or a pediatrician can select a specific drug and prescribe its dosage. Doctors often recommend treating sinusitis in children with the drugs Isofra, Summed, Polydex, etc. Previously, Bioparox was used for this purpose, but now it is prohibited.

It is very important to correctly approach the use of antibiotics prescribed by a doctor for sinusitis. Their prescription should always be accompanied by additional prescription of antihistamines, antiallergic and anti-edematous medications. This could be Allerdez, L-Cet, children's Loratadine, etc. Suspensions and syrups are used for children, and tablets for older children. After completing therapy, it is advisable to take antiallergic drugs for a few more days to consolidate the effect.

The main mistake of most parents is trying to self-medicate sinusitis in a child. Folk remedies, of course, quite often give positive results in the fight against pathology, but they can also cause harm. Many alternative medicine recipes only temporarily postpone the problem, but do not help to get rid of it completely. Therefore, remember: no one can prescribe the most effective remedy for sinusitis - only a qualified otolaryngologist!

Conclusion

Sinusitis is a very dangerous and insidious disease that can cause a number of complications. It can develop gradually or progress rapidly.

The feasibility of using antibiotics and the choice of a specific drug depends on its stage. However, this can only be judged by the attending physician, so do not risk your health by not wanting to stand in line to see an otolaryngologist. Be healthy!

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