Hi

Thanks for the query

Pseudoephedrine is a sympathomimetic drug, with its principal action on the adrenergic receptor system causing vasoconstriction (narrowing of the blood vessels) in the nasal passages. Pseudoephedrine is used to relieve nasal congestion caused by colds, allergies, and hay fever.

Q: What is usually recommended for frequency of usage of pseudophedrine for sinus discomfort?

A: Pseudoephedrine comes in the following dosage:
a. 12-hour extended-release (long-acting) tablet
b. 24-hour extended-release tablet

Either of them can be used depending upon the compliance of the patient. Most of these tablets come along with a combination with either an antihistaminic or an anti-inflammatory.

In case of sinusitis we usually do not recommend pseudoephedrine as it causes dryness of the nasal mucosa combined with increased viscosity of the nasal secretions, which will actually worsen the sinusitis. Ideally, you will require saline and steroid nasal spray, followed by steam inhalation and a mucolytic (such as ambroxol or bromhexine).

Q: What is the cause for both sinus congestion and a regular headache specifically when it is before a rainstorm?

A: The congestion in the nasal mucosa following change of climate is due to nasal allergy, which leads to blockage of the sinus openings. Sinuses are the empty cavities in the skull to protect the brain. Once the sinuses are blocked secondary to the nasal congestion, there will be accumulation of the sinus secretions inside the sinus. This leads to increased pressure felt in the head and later followed by headache.

Q: What is the difference in these two medications?

A: Augmentin (Amoxicillin/clavulanic acid) - is a combination antibiotic consisting of amoxicillin trihydrate (a β-lactam antibiotic) and potassium clavulanate (a β-lactamase inhibitor). This combination makes it a broad spectrum antibiotic, with increased efficacy against amoxicillin-resistant bacteria that produce β-lactamase. This is the drug of choice for treating sinusitis.

Azithromycin is used to treat a wide variety of bacterial infections. It is a macrolide-type antibiotic. It works by stopping the growth of bacteria. It is usually prescribed for 3 days. It is also used in the treatment of the upper respiratory tract infection, ear infection and sinusitis.

In general, Augmentin is a much better drug than Azithromycin, but if an individual is resistant to penicillin group of drugs (Augmentin) and sensitive to macrolides (Azithromycin) then definitely the former will not be effective in treating the infection.

I presume, doctors could have declined performing surgery on your wife due to various medical reasons or if there is a small, solitary polyp.

My advice to you is to use steroid nasal spray (such as Fluticasone or Momentasone) and saline nasal spray followed by steam inhalation. Drink plenty of warm water; avoid coffee, chilled beverages, smoking, and alcohol if any. Also, try taking mucolytics (such as bromhexine or ambroxol) for reducing the viscosity of the nasal secretions.

Hope I have answered your query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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