Hold the Steroids for Acute Sinusitis

Acute sinusitis on CT

Acute sinusitis is on the rise again this time of year.  The common prescription for an antibiotic and ‘steroid pack’ is probably WAY overdone.  Most sinus infections start as a virus, usually a common respiratory virus causing symptoms for around a week before resolving.  The unlucky of us will then get a secondary bacterial infection that may warrant additional treatment.

Here is a Link to the Otolaryngology Practice Guideline on Adult Sinusitis which is helpful for physicians to review for proper evidence-based treatment of sinusitis (this covers acute and chronic infections, but admittedly little attention is given to the first seven days of sickness).  A good Cochrane review on acute use of systemic steroids is here.

The evidence says NO to oral steroids (such as prednisone or methylprednisolone) for acute uncomplicated sinusitis.  Oral steroids may help moderately with symptom relief for a few days but the 30 day outcome is the same.  Serious adverse events are uncommon however so it is still common practice many places.

In general, uncomplicated acute sinusitis is treated conservatively for 7-10days, assuming a self-resolving viral infection is to blame.  Oral decongestants, NSAIDs, saline nasal rinse, nasal steroids all are helpful.  When symptoms are persisting longer than expected for a viral illness then generally we turn to an appropriate antibiotic class and duration.  Relapsing infections should consider early sinus CT imaging to confirm diagnosis.