Q. What is the treatment for sinusitis?

Hi doctor,

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.