Use of topical medications for sinusitis or allergic rhinitis has been demonstrated to help manage symptoms and assist in clearing infection. Initially, this included use of nasal sprays such as intranasal steroid sprays (Flonase, Nasacort). However, more recently, physicians have found that the use of topical antibiotics delivered via nasal irrigations can be very helpful in treating chronic sinusitis.
Anti-inflammatory agents including steroids may also benefit the patient. For example, some patients have persistent sinus infection that is difficult to resolve with oral antibiotics. This type of infection may persist even after adequate surgical or procedural management. In these patients, we’ve used topical antibiotics that are based on culture results with success.
Gentamicin is a common antibiotic used for topical delivery to the sinuses. This has been shown to be particularly effective after adequate sinus surgery has restored the openings of the affected sinuses. In this situation, a high concentration of antibiotic is delivered directly into the sinus cavities and results in effective clearing of bacterial infection. Other antibiotics such as vancomycin can be particularly effective in controlling chronic sinus infections.
During the sinus procedure, these antibiotics are delivered via saline irrigation so that an adequate volume is able to be delivered directly into the infected sinuses. Topical antibiotics can be delivered for protracted periods of time since they are not absorbed into the GI tract or bloodstream. Consequently side effects are also very restricted.