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Sinusitis, Steroids and Antibiotics
An_190887 posted:
Does anyone else have an allergy doc that uses prednisone as their first go-to in treating sinusitis?

I came from the doc yesterday on a 5-day course of prednisone. In addition to this he started me on a 14 day course of Clarithromycin (1000mg/day).

I don't like taking either kind of medication and resist but he told me this was the only way to eliminate the inflammation (granted it may be pretty bad - I have been traveling and "managing" my symptoms with OTC for almost a month and gave in and went to the doc when it turned into a fever over the weekend)

What wigged me out though, is that he also wants me to do Advair HFA 115-21 twice a day (2 puffs each time). When I went to get the scripts filled, the pharmacist counseled me on the dangerous potential interaction between Clarithromycin and the Advair.

Yet, when I do research, everything I can find indicates that antibiotics are not indicated unless there is an underlying bacterial infection (is there one?...I don't know - how WOULD I know) and I find nothing on the use of steroids to treat sinusitis.Suffice it to say, I am not going to use the Advair while using the antibiotic.

Does anyone else have any experience or advice on this?
Aqua14 responded:
Did your doctor tell you why he was prescribing the Advair? For example, if you have developed reactive airways (i.e., inflammation in your lungs manifesting in wheezing) because of the sinus infection, the Advair would control the inflammation in your lungs. Or, if you have already been diagnosed with asthma, the Advair would control an asthma flare that usually occurs after an upper respiratory infection. But really you need to ask your doctor why he prescribed it.

It's typical for a doctor to prescribe a NASAL steroid spray (Flonase, Nasonex, etc.) to treat a sinus infection. The effectiveness of nasal steroids in treating sinusitis has been proven in several clinical trials. An oral steroid like prednisone would be prescribed if the nasal inflammation were severe, to reduce the degree of nasal tissue swelling and congestion.

It's pretty typical for a doctor to prescribe an antibiotic to treat sinusitis; the doctor assumes that there is a bacterial infection, which would be a good guess here if you were running a fever. Clarithromycin (Biaxin) is one of the typical antibiotics prescribed to treat sinusitis. It would, however, concern me that your doctor was unaware of the adverse interaction of Advair with this antibiotic. It would make me think that he was not very familiar with prescribing Advair, especially since there are several similar medications that could have been prescribed that do not have an adverse interaction with Biaxin.

You sound like you do not have very much confidence in your doctor's abilities. Perhaps it's time to seek a second opinion.

Take care and good luck. Judy
It's never too late to be what you might have been. ~ George Eliot. A journey of a thousand miles begins with a single step.
Mimi_413 replied to Aqua14's response:
Thank you, Judy for taking the time to share this valuable information with me. You were correct when you surmised I was not confident in that doc.

He was part of a practice I had started with more than a decade ago. While I was comfortable with the founding physician, one of the docs there made me uncomfortable because he seemed put out when I would question anything. Short term, I had decided not to see anyone but the founding physician but have since found a new provider who is a partner in my health care.

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