Wednesday, July 11, 2012


Pharmacological sinusitis treatments

Antibiotics have little effect in the treatment of patients with acute rhinosinusitis and are often used unnecessarily. In the case of purulent infections, the duration of the treatment is 10 to 14 days depending on the symptoms. The antimicrobial of choice is amoxicillin at high doses. The second line antimicrobial is amoxicillin + clavulanic acid or cefuroxime. In the case of penicillin allergies, quinolones may be used. In general, the macrolides do not have good results with this pathology.
How do they work?

Amoxicillin is a broad-spectrum penicillin, effective against gram+ and gram-, with better pharmacokinetic characteristics than other penicillins. When combined with clavulanic acid, a penicillin inhibitor, the spectrum of action increases considerably. 
The macrolides act by inhibiting the synthesis of the bacterial proteins by binding the 50S subunit of the ribosome and by inhibiting the translocation of the peptides. It is active against gram+ and gram-.

What should be recommended for their proper use?:
In the case of a suspension, turn the bottle upside down to release the powder. Read the reconstitution instructions carefully and add the necessary water. Shake before using. Once the suspension has been reconstituted, store in the refrigerator for up to 14 days if it is amoxicillin, 7 if it is amoxicillin-clavulanic, 3-5 if it is azythromycin and 15 at room temperature if it is clarithromycin. Be certain the reconstitution is correct and occurs once!
Do not withdraw the treatment before 7 days even if there is improvement and take at regular intervals.
Gastrointestinal absorption and tolerance are promoted when amoxicillin-clavulanic acid is given just before meals since it provokes nausea, vomiting, diarrhoea in 1-10% of the population. Cefuroxime should be taken with food. Azythromycin interacts with food and it must be taken half an hour before or 2 hours after meals. Clarithromycin may be taken with or without food, although better with food. In general, probiotics are recommended to avoid undesirable intestinal effects.
The use of antibiotics may give rise to stomatitis, candidiasis and cutaneous hypersensitivity reactions.
Do these drugs interact with other medicinal products?
  • Amoxicillin and amoxicillin-clavulanic may interact with allopurinol, oral anticoagulants, oral contraceptives, naproxen, nifedipine, antacids and digoxin.
  • Macrolides may interact with statins.
  • Azithromycin may interact with ergotamines.
  • Clarithromycin may interact with fluoxetine.

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