decreases small vessel & capillary permeability (reduces swelling)
CNS Depression (somnolence)(50%)
BENADRYL (DIPHENHYDRAMINE) 25-50mg PO BID
DRAMAMINE (DIMENHYDRINATE) 50mg PO BID-TID
ANTAZOLINE (VASOCOR A; VASOCON A)
CHLOR-TRIMETON (CHLORPHENIRAMINE) 2-4mg TID-QID
DIMETANE (BROMPHENIRAMINE) 4-8mg TID-QID
PHENERGAN (PROMETHAZINE) 25-50mg BID-QID
Antihistamines have no direct role in the treatment of sinusitis, and may perpetuate it by thickening mucous. They are useful in treating related allergy symptoms only!!!
help promote drainage and decongestion of swollen sinus mucous membranes.
conversely, they can excessively dry nasal mucosa, thereby impairing the mucociliary transport system.
increase blood pressure
mucous membrane drying
Antibiotics are the mainstay of treatment of acute and chronic sinusitis.
Adjunctive treatment, such as the use of decongestants and antihistamines, serves only to reduce the symptoms of the sinusitis, and not eliminate the causative agent.
Generally, sinusitis is managed with both antibiotics and decongestants
Antibiotics of Choice
Amoxicillin-clavulanate (Augmentin) 500/125 TID
*ECN/Sulfisoxazole (Pediazole)* 5cc BID-TID
Trimethoprim-sulfamethoxazole (Septra DS) BID
Cephalexin (Keflex) 500 TID
*Clarithromycin (Biaxin) *500 BID
*Azithromycin (Zithromax)* 250BID day one then QD X 4D
A Word of Caution
sedation has been the major complaint with traditional antihistamines, such as Benadryl (diphenhydramine).
newer antihistamines have significantly reduced incidences of sedation
also require less frequent dosing (QD to BID).
1-10mg cap QD
Used alone or with decongestant
5 or 10mg QD
no reported cardiac interactions
Macrolide antibiotics and certain antifungal agents in conjunction with Seldane (terfenadine) and Hismanal (astemizole) have been reported to increase levels of the antihistamine to toxic levels, causing cardiac arrythmias and death