I am a 69 year old male and retired internist. Other than vitamins and prostate-related herbs, I take no medication. I have no allergies and have never smoked. My past medical or surgical history is rather unremarkable. I have had several bouts of acute sinusitis in years past. Four weeks ago, my wife and I developed URTI. My illness had a sinus component featuring marked nasal and sinus congestion, postnasal drip, upper airway congestion and cough productive of clear sputum. I assumed the etiology was viral and treated it as such. After two weeks of little improvement, I assumed a bacterial etiology and initiated Augmentin 875 mg bid. After five days with little improvement, I switched to Cipro 500 mg bid. After four days, I saw my primary care doctor who prescribed Azithromycin 500 mg per day. Following the second day of treatment, I developed severe fatigue, generalized weakness and headache, which forced me to discontinue the Azithromycin. I then decided to wait until the Zithromax cleared my system before re-evaluating. After some eight days, I developed a purulent nasal discharge for which I again saw my primary care MD who prescribed Doxycycline 100 mg bid. Note that I requested a culture and sensitivity of the purulent discharge but was rebuffed. After 24 hours on Doxycycline, I felt greatly improved with little sinus pressure or congestion and minimal, clear nasal discharge. Now, on day four of Doxycycline, I have noted some return of the sinus pressure, post-nasal drip and nasal congestion. However, the mucus is clear. I was given a steroid nasal spray which only served to increase the mucosal irritation of my sinuses, nasal passages, throat and upper airways. I was never febrile at any point. I am exceedingly frustrated. Note that in the past I used Levaquin and developed marked insomnia and very lucid dreams when I was able to sleep. Please help.
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You are suffering from chronic sinusitis. And I feel this is all allergic and you do not need antibiotics.
Usually an acute attack takes five days to settle down. But, if you have persisting sinusitis, you would require CT paranasal sinuses.
If the CT shows slight sinus infection, then it can be treated with conservative treatment. But, if the infection is severe, you would require surgery for the same.
The conservative management of sinusitis includes the following:
Please share my opinion with your doctor before acting upon it. I hope it helps.
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