Medication Summary
The goal of pharmacotherapy is to reduce morbidity and prevent complications.
Decongestants
Class Summary
Decongestants establish ventilation of the sinuses and relieve pressure, pain, and edema. Combine topical and oral decongestants in most cases, especially for acute symptoms. Topical agents are frequently useful when oral agents are contraindicated.
Oxymetazoline 0.05% (Afrin, Allerest, Chlorphed, Dristan)
First-line therapy for topical decongestion. Applied directly to mucous membranes, stimulating alpha-adrenergic receptors and causing vasoconstriction. Decongestion occurs without drastic changes in blood pressure, vascular redistribution, or cardiac stimulation.
Phenylephrine nasal (Neo-Synephrine)
First-line topical decongestant if a shorter-acting agent is preferred. Strong postsynaptic alpha-receptor stimulant with little beta-adrenergic activity that produces vasoconstriction of arterioles in the body.
Phenylpropanolamine (Rhindecon, Unitrol, Phenyldrine)
Recalled from US market. First-line oral decongestant. Epinephrine stores are released under phenylpropanolamine stimulation and produce alpha- and beta-adrenergic stimulation. These effects may increase outlet resistance.
Pseudoephedrine (Actifed, Sudafed, Afrin)
First-line oral decongestant. Stimulates vasoconstriction by directly activating alpha-adrenergic receptors of the respiratory mucosa. Induces bronchial relaxation and increases heart rate and contractility by stimulating beta-adrenergic receptors.
Antibiotics
Class Summary
Antibiotics control infection either as an inciting factor in the barosinusitis or as a sequela of the barosinusitis.
Amoxicillin/clavulanate (Augmentin)
Drug combination treats bacteria resistant to beta-lactam antibiotics. First-line therapy for persons not allergic.
Trimethoprim/sulfamethoxazole (Bactrim, Septra)
First-line therapy in patients allergic to penicillin, although adverse effect profile may make other agents more desirable.
Cefuroxime (Ceftin, Zinacef)
Second-line therapy, but may be first-line therapy in patients who are allergic to penicillin.
Amoxicillin (Trimox, Amoxil)
Interferes with synthesis of cell wall mucopeptides during active multiplication resulting in bactericidal activity against susceptible bacteria.
Analgesics
Class Summary
Acetaminophen, with or without codeine, is useful for pain control.
Codeine/acetaminophen (Tylenol and codeine)
First-line analgesic for severe pain. Fixed combination Tylenol #3 is 300-mg acetaminophen with 30-mg codeine.
Acetaminophen (Feverall, Tempra, Tylenol)
DOC for pain in patients with documented hypersensitivity to aspirin, NSAIDs, upper GI disease, or on oral anticoagulants.
