Question by college_gal: Can all my medicines im taking be the reason I keep getting chronic sinus infections? Pharmacist or doctors.?
I have asthma and take Advair HFA everyday, twice a day along with nasacort (nasal spray) and Singular 10mg once a day. For the past 8 months or so I have had around 5 to 6 sinus infections. each time i get put on either amioxicillen or a Z pack along with Prednisone for my asthma. Is it possible that the infection isn’t going away because I do take so many medications on a daily basis which may be altering my immune system?
Clint,
1) i actually do not know the dose on prednisone, i recently threw away the box. but it was taken over a six day period and taken only at certain times during the day
2) I have had asthma my entire life (19 years) and have been taking medication of the sort for around 9 years
3)When on the Z pack it has ranged from a 3 day pack to a 6 day pack and the amoxicillen was normally taken for about two weeks when prescribed.
4) for the last three I have been prescribed z-pack 6 day (azithromyci 250 mg), prednisone, Lodrane, and a nasal spray.
5) I am unaware of any anatomical defects and no I have not had a CT snan of my paranasal sinuses. About 5 years ago my nasal passage was looked at with a camera because i had amy abdnoidds taken out along with my tonsils.
Best answer:
Answer by Clint
Thank you for the question. I’m sorry to hear about this problem.
I can sympathize with you, because sinusitis used to plague me when I was a teenager before my specialists found the cause. Allergy/sinus disease is one of my special interests in medicine.
First, the Advair, Singulair, and Nasacort are not causing your recurrent sinusitis.
However, your question about the possible immunosuppressant effects of your medications is legitimate, which brings us to your medication prednisone, which is both a potent anti-inflammatory agent, but at certain dosages and if used for a prolonged time period, is also a suppressant of the immune system.
If I may ask for additional details,
1. What is the dosage of prednisone (how many milligrams)?
2. How long have you been taking this medication for asthma?
My next concern is whether these recurrent sinus infections are truly discrete new infections or actually represent a single infection that has been partially treated with a weak antibiotic for an inappropriately short treatment period.
If I may ask,
1. For each “episode” of a sinus infection, for how many days has your doctor treated you with an antibiotic? 5 days? 7 days? 10 days? 14 days? or 21 days?
2. Which antibiotic have you been prescribed for the last three infections?
My next concern is whether you have poorly controlled “risk factors” for recurrent acute sinusitis, of which you likely have one major one: allergic rhinitis (nasal allergies or hay hever), which I am assuming that you have because you are on Nasacort, unless the Nasacort was prescribed to help treat your sinus infection. Other common risk factors include structural or anatomical defects, such as a deviated nasal sepum, antral cysts (cysts in the maxillary sinuses), and polyps in your nasal passages. Any of these anatomical defects can block the natural drainage of your paranasal sinuses, which over time can lead to a cauldron of retained secretions in your sinuses and provide a breeding ground for bacteria.
If I may ask, are you known for having any of these anatomical defects in your nasal passages/sinuses?
Also, have you had a CT scan of your paranasal sinuses? Have you ever had endoscopic surgery on your sinuses?
ADDENDUM:
Thank you for the additional history.
If you are being prescribed prednisone for six days for asthma flares, it’s unlikely that this medicine is suppressing your immune system to where it is clinically causing susceptibility to infection. The exception would be if your asthma was so out of control that you require prednisone “bursts” 2 or 3 times per months.
Next, in my experience, a “Z-pack” or azithromycin, is a sub-optimal choice for treating acute sinusitis. As is amoxicillin. If you’ve been treated repetitvely with these antibiotics over the past eight months, then I am concerned whether the bacterial species(s) that is (are) causing these infections (or infection, if this is in fact a single infection) has become resistant to these antibiotics.
In my practice, I always treat acute sinusitis very aggressively, both in terms of the “power” of the antibiotic and the duration of treatment, in order to achieve a better cure rate. Provided the patient does not have an allergy to penicillin, I always treat with Augmentin XR twice daily for 21 days. Augmentin XR is a much stronger form of amoxicillin, because it is a much higher dose and it contains a second component medicine that helps overcomes the resistance mechanism of bacteria to amoxicillin. Granted, Augmentin XR is much more expensive than plain amoxicillin, but it is hands down superior in treating sinusitis, and I think that you would be a good candidate for a “salvage” treatment of this problem with Augmentin XR.
As an adjuct to this treatment (and it sounds like you may already be doing this), daily irrigation of your nasal passages with saline spray/stream is very helpful in facilitating cleatcne of the infection. I strongly recommend performing this irrigation LIBERALLY to help remove discharge from blocking the ostia (openings) from your sinuses into your nsasal passages. I recommend irrigating three times daily at a minimum until the infection clears.
Finally, I would strongly recommend that you undergo a CT scan of the paranasal sinuses. Five or six sinus infections in eight months are five or six too many in my book. I would be willing to go out on a limb that you have some structural defect in your nose/sinuses that is predisposing you to so many infections. And if so, you would be a good candiate to undergo endoscopic procedure from an ENT specialist to see if the problem can be corrected. That’s how my problem was found, corrected, and CURED many years ago.
Please, I would encourage you to discuss these issues with either your internist or allergist/asthma specialist.
I hope this helps. Take care.
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