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Old 01-14-2009, 06:13 AM   #1
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Oral steroids w/out antiobiotics for chronic sinusitis?

Has anyone ever been prescribed a short course of oral corticosteroids alone (no antibiotics) for chronic sinusitis? After taking a look at me, my ENT saw a lot of inflammation but little sign of infection. He was reluctant to prescribe antibiotics without a clear indication, since, when this started in December, I had a bad GI reaction to the Omnicef he prescribed and had to stop taking it. So he prescribed oral steroids for 6 days, along with continuing use of a nasal steroid spray.
This is my first experience with chronic sinusitis (diagnosed by CT - mild chronic pansinusitis), and I am a tad confused over this whole thing. Most websites indicate the use of antibiotics or antibiotics and steroids for chronic sinusitis, and I havent seen anything on the use of steroids alone. I have a little worry about the steroids making any underlying infection worse, but, on the other hand, I want to avoid antibiotics unless they are ABSOLUTELY necessary, given my last experience. Any thoughts/comments would be much appreciated - this board has been a lot of help already!

 
Old 01-14-2009, 06:55 AM   #2
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Re: Oral steroids w/out antiobiotics for chronic sinusitis?

if the inflammation is eliminated by the steroids, your sinuses should drain on their own. If you don't have any green mucous, you probably do not have infection

 
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Old 01-14-2009, 07:08 AM   #3
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Re: Oral steroids w/out antiobiotics for chronic sinusitis?

Hey Doly:

You seem pretty knowledgeable on the subject. I am going thru this the first time but it has been since November. So If I only have mostly White with some yellow that probably is not an infection. I finshed 6 weeks of 2 different antibiotics a week ago. He kept me on Astellin 2 times a day, neti-pot, steam as he said there was still a lot of congestion. He wanted to re-run a CT in like 2 months to see how I progressed. First CT scan showed Para Sinusitis. I have a follow up in 10 days

I do still feel a little fatigued but I was on antibiotics for a 6 to 8 weeks and steroids 2 times for 5 days

Any advice would be appreciated

 
Old 01-14-2009, 07:19 AM   #4
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Re: Oral steroids w/out antiobiotics for chronic sinusitis?

When i was on antibiotics last year, i actually had energy.. couldn't believe it. I'm currently trying allergy shots to see if that relieves some of my symptoms. When i finally got a CT Scan and went to a ENT, he said i had pristine sinuses. I was pretty disappointed. My Naturopath/chiropractor suggested i eliminate or watch my wheat with my symptoms. I've tried but when you don't really eat fruits and veggies it is hard.

You may want to try the neilmed sinurinse bottle. It has a little more force. Maybe the neti pot with just gravity isn't getting enough out. I know if i feel like i'm getting a sinus infection i'll add 1/2 a capful of peroxide to each neti pot. If you do too much it will BURN! Some people have luck with the upside-down flooding. I can't remember if it is on this forum or the allergy forum

Good luck! really the only thing you can do with sinusitis is manage your symptoms. I irrigate daily, in the winter more for the moisture

 
Old 01-14-2009, 07:38 AM   #5
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Re: Oral steroids w/out antiobiotics for chronic sinusitis?

I use the Neil Med packets but not the spray. I use the Neti Pot. I can to buy the spray. I also put a 1/4 teaspoon of baby shampoo in as per the ENT. He also reccomended putting in a 1/2 of cap full of Alkohol. Which is similiar to your peroxide. So you think the infection might be gone or on its way?

Other thing I may do is I have a migraine condition and I take a Beta Blocker which can cause congestion. I can try and switch to a calcium channel I was on a few years ago

Thanks for your help and advice

 
Old 01-14-2009, 08:23 AM   #6
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Re: Oral steroids w/out antiobiotics for chronic sinusitis?

Thanks for the response - I have a lot of mucus, but the vast majority is clear, sometimes a cloudy white. I have had two or three instances over the last couple of weeks with tiny dots of more yellowish material, but not often and not much. And I guess the ENT didn't see any suspcious discharge when he looked up my nose with the light.
I will try not to worry and just go with the flow - not easy. This is my first experience with this, though it looks like it will not be my last.
My ENT's advice was almost identical to yours - all you can do is manage the symptoms and try to head infections off with the nasal irrigation, humidifiers, etc.

 
Old 01-14-2009, 08:43 AM   #7
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Re: Oral steroids w/out antiobiotics for chronic sinusitis?

the neilmed sinurinse is a squirt bottle. I use the cvs saline packets 1/2 per neti pot and 1/4 glycerin because i get so dry

 
Old 01-15-2009, 04:19 AM   #8
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Re: Oral steroids w/out antiobiotics for chronic sinusitis?

Quote:
My ENT's advice was almost identical to yours - all you can do is manage the symptoms and try to head infections off with the nasal irrigation, humidifiers, etc.
There are some other things you can do. The biggest challenge in dealing with chronic sinusitis is trying to get a handle on what's causing it and dealing with the underlying cause, which is usually allergies, acid reflux, some kind of chemical/environmental irritant, or an immune disorder.

You might want to see an allergist/immunologist to get tested for allergies (they'll often do a blood test to make sure that you don't have an immune system imbalance as well). If you have any kind of acid reflux it's really important to aggressively treat that as well.

Getting the underlying cause under control medically can really help you head off infections and keep the sinusitis from becoming more serious.

By the way, the steroids without antibiotics are very common and the dosage and length of time you take them typically aren't enough to impact your immune system so it's extremely unlikely that a short course of steroids would cause a bacterial infection to worse. Taking the steroids to get the inflammation under control should help your sinuses to function more normally.

 
Old 01-15-2009, 06:17 AM   #9
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Re: Oral steroids w/out antiobiotics for chronic sinusitis?

That's very helpful information. I haven't had allergies in the past, but I know that can change at any time, so it may well be worth having it checked out. I'm pretty sure acid reflux isnt an issue - I don't have any of the symptoms and I recently had an upper GI scope for an unrelated issue, and there was no evidence of reflux.
My CT showed a lot of structural 'abnormalities' in the sinuses, including a significantly deviated septum, which doesn't help. My ENT doesnt want to even think about surgery unless I start to have really signficant problems - a stance I agree with, since the thought of surgery is not exactly appealing.

I truly appreciate the advice - my ENT is good (I think!) and quite nice, but no doctor these days has the time to spend hours with every patient, and so hearing from others who've dealt with these issues is incredibly helpful.

 
Old 01-15-2009, 06:44 AM   #10
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Re: Oral steroids w/out antiobiotics for chronic sinusitis?

I agree very helpful...I never had a sinus infection so this is all new to me and this lessoned my worries. I agree with you about any surgery. Try to manage the symptoms first...

 
Old 01-16-2009, 11:19 AM   #11
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Re: Oral steroids w/out antiobiotics for chronic sinusitis?

Doly:

I bought the bottle for Neil intead of the Neti pot. You are right so much more crap comes out... Actually may still have an infection as some yellow and gree once came out but I really dont want to go on an antibiotic anymore. I feel much more energy lately. I will continue to irrigate as I see the doctor in 2 weeks. I use a nasal spray as well

Howie

 
Old 01-16-2009, 11:24 AM   #12
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Re: Oral steroids w/out antiobiotics for chronic sinusitis?

Good to hear! i would irrigate 2-4 times a day if possible. If no antibiotics etc, keep flushing, dont' let it take hold.

One thing i forgot to mention that i learned on another group. You can use pepcid ac chewable and a chewable vitamin C and put them in the back of your mouth. Don't chew them, more like a lozenge. It helps draw out the gunk. Some get the membranes from whole pecans and either suck on them, or brew a tea. I've used the pepcid/vit c. It helps, reasonably inexpensive

 
Old 01-16-2009, 11:53 AM   #13
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Re: Oral steroids w/out antiobiotics for chronic sinusitis?

My doctor has me adding a 1/4 of teaspoon of Baby Shampoo to draw the junk... Yeah I dont think this a new infection just these things take time to leave .. I will flush 4 times a day. I was doing 2. MY infection was pretty bad so because of the frigid weather, and heat, and colds going around it is lingering so I need to keep flushing. I am also drinking a lot of water. Hopefully I dont need any more meds... I have been taking Acidophilus to put some bacteria back in my system... I was on Augmentum for 4 weeks and bactrim for 10 days

I will try the Pepcid AC/Vita C
How often to use suck on them?

 
Old 01-16-2009, 11:59 AM   #14
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Re: Oral steroids w/out antiobiotics for chronic sinusitis?

some do twice a day. I just did it at night. Too much vit c upsets my stomach. Augmentin is nasty!

 
Old 01-16-2009, 12:09 PM   #15
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Re: Oral steroids w/out antiobiotics for chronic sinusitis?

Yeah thats what sucks..If the Antibiotics dont work and the oral steroids dont....You feel 20x worst from all the side effects plus the infections.....

Your almost trying naturally as these antibiotics dont always work

 
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