‘Tis the Season: Compounded Sinus Treatment for Acute and Chronic Rhinosinusitis

‘Tis the Season: Compounded Sinus Treatment for Acute and Chronic Rhinosinusitis

i-bottleThe arrival of fall can bring a host of unwelcome illnesses and compounding pharmacists often expect to see an uptick in demand for sinus treatment medications. The change of seasons from summer to fall often causes patients to develop sinus infections of various severity, though sufferers of chronic rhinosinusitis or acute sinusitis can battle these infections year-round.

As with the common cold or other perennial illnesses that befall a large percentage of the population, there are are plenty of treatments for sinusitis available, from old wives’ tales to home treatment to solutions from health care providers. For patients who show signs of chronic and uncomfortable rhinosinusitis, topical and transdermal compounded sinus treatment can be a welcome relief.

Acute and Chronic Sinusitis: What Pharmacists Should Know

Acute rhinosinusitis is diagnosed when the nasal cavities and paranasal sinuses surrounding the nose become inflamed, causing the patient to drain thick yellow or green discharge from the nose and throat. The acute condition lasts less than four weeks and comes in two varieties, viral and bacterial. The most common type is acute viral rhinosinusitis, which many people experience as part of a bout of the common cold, usually accompanied by cough, sore throat, and facial swelling and aches. This type usually resolves itself in about 10 days, which can also happen with the bacterial form.1

Not all patients with sinusitis will need antibiotics or other medication to treat acute sinusitis. For patients whose sinusitis is a side effect of a cold, other treatment options may be tried first, including steam inhalers, nasal irrigants, over-the-counter decongestants and nasal sprays. Over-prescribing of some broad spectrum antibiotics for sinusitis can lead to antibiotic-resistant strains, especially the over-prescription of amoxicillin or trimethoprim/sulfamethoxazole (TMP/SMX) for patients who suffer repeated episodes of rhinosinusitis that becomes chronic.2

Generally, the symptoms of chronic rhinosinusitis manifest very similarly to acute rhinosinusitis, except that the chronic version lasts longer than four weeks despite treatment and can exhibit more severe symptoms and outcomes. Patients can have multiple bouts of acute sinusitis lasting less than a month before developing a chronic condition, which carries a higher risk of serious infection. Any patient with sinusitis symptoms should see a medical professional immediately if they exhibit any double vision, shortness of breath, swollen forehead or eyes, or a severe headache.3

How Compounded Sinus Treatment Can Help Sinusitis Sufferers

Most sinus treatment involves reducing pain in the facial area where the nasal cavities cause discomfort, clearing the nasal passages of mucous and discharge, and helping the patient maintain open sinuses. Many of the treatments can be compounded to meet patients’ needs regarding allergies, physical limitations or decreased efficacy in a frequently used drug.

Topical creams can provide pain relief to the areas of the face where patients can feel soreness from the inflammation, including around the nose and along the jaw. Throughout the duration of a patient’s cold, nasal fluids can be forced into the sinuses, causing the goblet cells in the affected sinuses to produce the mucus-thickening agent mucin. The mucus will partially or completely block the ostia, leading to pressure inside the sinuses and pain in the facial area. Compounded topicals and transdermals can ease the pain caused by the sinus pressure when applied directly and in accordance with a medical professional’s instructions.4

Nasal corticosteroids can help treat existing nasal passage inflammation or prevent future buildups. Common examples, such as Flonase, can be compounded from quality bulk APIs like fluticasone, and compounding pharmacies can formulate varieties tailored to patients with allergies to certain compounds. More severe cases of chronic rhinosinusitis where nasal polyps are present might be treated with stronger oral corticosteroids like prednisone, with a higher risk of side effects.

OTC decongestants can also be used in concert with other compounded sinus treatments to provide temporary relief from painful cough and congested chest cavity symptoms.5 However, pharmacists should also note that the Food and Drug Administration prohibits nonprescription products from carrying the wording “for the temporary relief of nasal congestion associated with sinusitis,” as a result of the debate leading up to its 2005 “Amendment of Final Monograph for Over-the-Counter Nasal Decongestant Drug Products.” It is generally understood that decongestants were and are not prescribed by physicians as primary agents for compounded sinus treatment, but the agency’s concern over patient self-treatment with OTC medications led to extra caution on packaging wording.6

Sinus infections vary widely in severity and for patients whose sinusitis accompanies the common cold, self-diagnosis and self-treatment with treatments like handheld steam inhalers or over-the-counter options can be the answer. For patients who need prescription relief from pain or to assist with clearing nasal passages and addressing acute or chronic sinusitis, however, compounding pharmacists can assist with options. For many, application of a topical cream or use of a nasal spray can be the difference between sinus misery and being able to enjoy the beauty of the fall season.

Pharmaceutica North America is the premier provider of high-quality compounds for pharmacists and physicians to create compounded medication for the best patient care, including topical treatments for sinus infections chronic rhinosinusitis. To learn more about our bulk APIs, including fluticasone, or custom compounding kits, contact us today.

Show 6 footnotes

  1. “Acute sinusitis and rhinosinusitis in adults: Treatment,” May 26, 2015, http://www.uptodate.com/contents/acute-sinusitis-and-rhinosinusitis-in-adults-treatment
  2. “Sinus Infection,” Nov. 13, 2014, http://www.emedicinehealth.com/sinus_infection/page9_em.htm
  3. “Treatments and drugs,” July 2, 2013, http://www.mayoclinic.org/diseases-conditions/chronic-sinusitis/basics/treatment/con-20022039
  4. “What Can the Pharmacist Recommend for Sinus Problems?” 2007, http://www.medscape.com/viewarticle/562176
  5. “Sinus Infection,” ibid.
  6. “What Can the Pharmacist Recommend for Sinus Problems?” ibid.
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