Prednisone for Sinus Infection
Prednisone is a commonly prescribed medication for sinus infection due to its ability to reduce inflammation and alleviate symptoms. Sinus infections can be painful and debilitating, impacting your ability to breathe comfortably and perform daily activities.
In cases where symptoms persist or become severe, healthcare providers may prescribe prednisone, a corticosteroid medication, to alleviate inflammation and promote sinus drainage. In this blog post, we will delve into the role of prednisone in treating sinus infections, its effectiveness, and potential side effects.
Check out my latest video about prednisone for sinus infection and find out what I recommend instead when you have a respiratory infection.
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What is Prednisone?
Before discussing its role in sinus infections, let’s understand what prednisone is and how it works. Prednisone is a synthetic corticosteroid that mimics the effects of cortisol, a hormone naturally produced by the body. It is commonly prescribed to reduce inflammation, suppress the immune system, and manage various conditions.
Prednisone for Sinus Infection
Transcription autogenerated from the video above so some errors are possible.
Did your doctor prescribe this for your sinus infection? Mine sure did, and it’s totally wrong. I should not have been given Medrol Dose Pak for a sinus infection and it is totally inappropriate if you have a sinus infection. Also, antibiotics totally inappropriate most of the time if you have a sinus infection.
Hi, I am Dr. Megan, your prednisone pharmacist, why would I make such a strong statement about steroids for sinus infections? Well, it turns out there’s no good evidence that they help, that they work, that there’s any benefit over not using it. They recently did a study in 2020. They said;
Almost 10 million people have been prescribed steroids for an acute respiratory tract infection.
What is an acute respiratory tract infection? Could be anything from acute bronchitis, sinusitis, pharyngitis, otitis media, ear infection, allergic rhinitis, influenza pneumonia, and unspecified upper respiratory tract infection, laryngitis, acute sinusitis, or a sinus infection. I’ve personally been diagnosed in the last few weeks with otitis media, which is an ear infection.
They’ve given me amoxicillin for seven days for the ear infection. It didn’t clear it up, so I waited a week, still no help, so I went to a different doctor. They said I have a sinus infection and then prescribed antibiotics and steroids.
In this study, when they had 10 million people with a possible acute respiratory tract infection, almost 12% were prescribed a steroid or glucocorticoid (corticosteroid). It could either be an injectable one or a pill like I was prescribed.
What was amazing is when they looked across the United States, there was a remarkable geographic variability is what they said. The patients who lived in the Southeast were 14 times more likely to receive a steroid injection as opposed to people who lived in the Northeast.
The rate of prescribing steroids for an acute respiratory tract infection almost doubled from 2007 to 2016, even though there’s zero evidence of benefit, one of the doctors who published it said specifically, there’s practically zero evidence of benefit. Dr. McCool said;
It’s important for the public to understand that most operatory upper respiratory tract infections are self-limited. No intervention is required. They resolve on their own. If you don’t seek care about 70% of the time, if you get an infection (sinus infection) it will go away without the doctor doing anything.
When they compare to a placebo drug (fake pills), it might’ve cleared it up a little faster. This is specifically what it said;
We recommend not using systemic glucocorticoids. That means steroids that go to your entire body when given in addition to antibiotics. Oral glucocorticoids may shorten the time to symptom resolution or improvement
You might have symptoms resolve a little sooner. Although the benefits are small and unlike topical glucocorticoids, that means something that goes right on the place where the problem is like a nasal spray. The full-blown systemic glucocorticoids pose a potential risk for side effects that outweigh clinical benefits.
What are the Side Effects of Steroids for Sinus Infection?
The side effects can be horrible and we wanna find out what those are. And I’ve gotta be clear with you, steroids have saved my life. I took prednisone for a bleeding disorder and it saved my life. These drugs can be complete miracles when they’re used for the right reasons. But when it comes to infection of the sinus, there’s no benefit. Find out what your risks are so you can really make that calculation for yourself better.
As few as three days of treatment with corticosteroids taken orally even by relatively young, otherwise healthy patients: gastrointestinal bleeding, sepsis and heart failure.
Three days is even in relatively young healthy people like me, just three days can cause an increased risk for those things. And elevated risk of diabetes and osteoporosis if you receive one or more shots per year of steroids. And Dr. Dvorin said;
Even brief use of steroids: elevated blood sugar, elevated blood pressure, mood and sleep disturbances, fracture and blood clots.
Even short-term use can cause increased risk for all of those side effects. And most of those are relatively rare. The typical person isn’t going to get all of those big scary side effects. But what are you more likely to have?
You are more likely to have hunger, cravings, rage, mood changes, sleep disturbances. And that’s crazy. why would you wanna take a drug like this that’s gonna cause you to lose sleep when sleep is one of the very most important things you need to recover?
I’ve lost my voice, I have laryngitis like yesterday, and I could barely talk today. Thank heavens. I’m getting a little bit more in my voice. And I have the typical symptoms of a sinus infection. I had a cold about four weeks ago and so did everyone in my family. Most of us lost our voice at that point. And then two of us got ear infections because we got so much swelling and pain in that area. I took the antibiotic and I thought I was getting a little bit better.
My voice did recover. And then over the last few days, it’s gotten worse. The ear pain isn’t getting any better. I have hearing loss and my voice, lost my voice, got coughing, pain, and fatigue. I just have not felt like myself for almost a month now and that’s pretty typical when it comes to a sinus infection.
What you should take for a Sinus Infection?
It’s pretty typical that you will have a viral infection like a cold and then a few weeks later you’ll get sick again. That’s a typical bacterial sinus infection. And most of them do go away on their own, which is fantastic. But if you’re having complications then you might need an antibiotic. A typical antibiotic that you would start with would be amoxicillin, which is what they did with me. They might add the little thing to it called Clavulanate and that makes it the augmented brand name.
That one can be really hard on your gut. A lot of these antibiotics cause a lot of side effects too. And the benefits may not outweigh the risks. My doctor, because I’m allergic to a lot of antibiotics and I’d already failed amoxicillin, prescribed Cefuroxime that’s a third-generation cephalosporin.
I’m hoping it’s gonna help because I’m at the point where it’s pretty clearly a bacterial issue and it’s been more than 10 days. At this point, bacterial infection is likely and it needs to be treated because I’ve already failed one round of antibiotics. I’m getting to the point where it might be chronic sinus.
Who should take Prednisone for Sinus Infection?
The doctor said if this doesn’t help for 10 days, I should come to refill it and do another 10 days because he doesn’t want it to become a chronic issues. The only people who really benefit from steroids and antibiotics who have sinus infections are those who have chronic sinusitis, which is more than four weeks, usually more than 12 weeks of nasal congestion, possible nasal or facial pain, and sinus pressure like your nose is always running.
Those are the main symptoms of sinus infections that are long-term. And if you’re having lots of congestion, then they might actually need to do a CT scan to see inside your sinuses do tests, and go through seeing an ENT with their fancy scopes to see for sure if you have a sinus infection and to make sure you don’t have sinus polyps. Because that’s who really benefits from sinus treatment with steroids.
Usually, this isn’t enough though you would need longer term than just six days of steroid treatment. And so it would probably be more like prednisone 30 milligrams for 10 days, two weeks, or even longer. It’s really dependent on your doctor and how severe your situation is. You wouldn’t generally see over 60 milligrams of prednisone for somebody who has chronic sinusitis. So that’s who can actually benefit.
What are the alternatives you can do instead?
I know you’re suffering, I know you feel yucky. Don’t take prednisone, throw it away. What should we do instead? And this is in order of most benefit.
Step one, is a pain medicine. If you’re having sinus pain and pressure, then over-the-counter medicine can help. There’s acetaminophen that is safe for most people except those with liver problems. You can take up to 4,000 milligrams a day, which in this case the extra strength, 500 milligram tablets is eight tablets per day.
Ibuprofen is another possibility. I’ve been taking both because I’ve been so miserable. And you can take up to four times three is 12 of these per day. If you’re really struggling, start with just one and see if that’s enough. You can go up to four per dose three times a day. And who should not use this? It’s people with kidney problems, heart problems, and gut problems, which is a lot of people. So ibuprofen and naproxen are also a possibility.
Next one that has evidence of benefit, I said that the menstrual dose pack or prednisone pills, are going to your entire body. That means they’re causing side effects everywhere, right?
A nasal spray is called a topical because it’s going to just one place in your body. This is one I recommend. It’s fluticasone and I get most of my over-the-counter medicines at Costco because it’s cheaper usually per dose and Fluticasone is a steroid like prednisone.
So they’re both steroids. But the difference is this is only going in your nose whereas this is going to your entire body causing mood changes and all of those horrible side effects that I mentioned before.
This actually does have evidence of the benefit of steroid nasal sprays. There are other versions, but fluticasone is definitely my favorite. And you just blow your nose first cover your one nostril and then you don’t wanna point at like your nasal septum in the middle of the nose. You wanna point straight up and squirt it while you’re sniffing and then repeat on the other side and you can do up to two sprays at a time. This is what I’d recommend over the steroids.
The next type of treatment that would be helpful. Another kind of nasal spray that doesn’t have anything in it. It doesn’t have any medication in it that’s just saline, just salt water. And those are fantastic to just kind of moisten and loosen the mucus that’s building up in the sinus nasal area.
And then another option is called a neti pot. I have several of these in my house. They are kind of weird when you use them, but they’re fantastic.
The little packet in it has salt essentially and it dissolves easily. And what you do is you pour that packet, the contents of the packet into the neti pot and then you gotta use bottled water or otherwise sterilized water. You don’t wanna use just plain tap water and you pour it in up to the line and you want it to be exact. The ratio of the salt to the water is to be precisely exact, otherwise, it can really burn your sinuses. The consistency of that salt water is the same, it’s called isotonic. The same balance of salt and water and things as what’s inside your mucus membranes. It won’t hurt if it’s the exact right ratio, but if you use too much or too little water and salt it’ll really hurt.
You also want the water to be at exactly the same temperature as your skin. So when you put your finger in it, it won’t feel hot and it won’t feel cold. It’ll feel the same as you touch your finger in it. So that is a fantastic option for people who have sinus issues.
Another thing is if you’re having lots of congestion and especially if you’re like me having eustachian tube dysfunction or ear infection, then a nasal decongestion like this with pseudoephedrine is fantastic. I use the immediate release maximum strength and I get the maximum amount of tablets at a time I can possibly get because you have to show your driver’s license in order to get these at the pharmacy.
And if I’m gonna have to go do it, I’d have to just get as many as I possibly can all at once. You can also get extended release versions that you don’t have to take as often. You’re gonna have to take every four to six hours convenience, you can use the extended release version.
The reason I don’t personally is because I want it to wear off before I go to bed because this can be stimulating, make you feel a little anxious or jittery for this isn’t appropriate for people who have high blood pressure and it says, or people who are taking a monoamine oxidase inhibitor or have thyroid disease have enlarged prostate glands or diabetes. So there’s a lot of people who can’t use this. But for somebody otherwise young and healthy like me, this is a fantastic thing to help thin out the mucus.
It’s called a decongest. And I personally take two of these at a time every four to six hours and I make sure that the four to six hours is gonna stop before bedtime so that I can sleep.
And then the next one would be antihistamines. This is called a first generation antihistamine. It’s just like Benadry. Some people antihistamines aren’t helpful because it’s drying out the mucus too much and that can be painful and harmful.
But for a lot of people this is really helpful. I take it at bedtime and I don’t want to take it during the day ’cause it makes me drowsy and makes me wanna fall asleep. Some people get what they call a paradoxical reaction and if they take it during the night they won’t be able to sleep. So make sure you know how it works for you. But for me and for most people it makes me really drowsy and helps me sleep while I’m having the sinus infection during the day. You can take second generation antihistamines like Allertec, which is cetirizine the brand name is Zyrtec or Loraine and there are several in this class of drugs.
They all work pretty much the same and all have very minimal side effects. So you can take this during the day. These are especially helpful if your sinus infection is related to seasonal allergies. So definitely take these, in some cases they’ll ask you to double the dose but definitely check with your doctor before doing that because normally you just take one pill of one of them per day and then that was the antihistamines.
Next is guaifenesin, it is a mucolytic is what it’s called. It helps break down the mucus in coughs like in your postnasal drip and stuff. So this one is just plain guaifenesin. The one I personally take and I need every 12 hours is Mucinex DM because I have had this cough for four weeks and lots of mucus.
So I take this every 12 hours. It’s a combination product. It has both guaifenesin and dextromethorphan, it’s like these bi-layer yellow and white tablets and it helps to suppress your cough. That’s what the dextromethorphan does and thin out the mucus of the cough. I take this like faithfully every 12 hours for the last four weeks.
Another product that I don’t currently have with me at the moment that if you’re having a cough along with your sinus infection is something that’s just plain dextromethorphan cough syrup. My favorite is called tussionex, it’s like an orange bottle and it lasts 12 hours as well.
So that one’s fantastic. It’s an extended release cough syrup that you just would take in the morning and at night I’m, it’s a lot easier for me to just swallow a pill because I generally remember after I brush my teeth and I don’t wanna have to like have a like sticky syrup after I brush my teeth.
Here are all the pills that I’m currently taking to deal with my sinus infection.
And then if you do have a cough, something that’s just honey, like honey tea, honey cough syrup, or just put some honey in some water is great for coughs.
Prednisone isn’t, it doesn’t really work. And then this is the my favorite cough syrup. I mean cough drops. They have all of these different herbs and several of them have a lot of evidence of benefit.
I’ve been using quite a few of these little babies and they taste fairly good. They aren’t like other cough drops that are like basically fancy candy that are just kinda like numbing candy. These actually have herbs in them so my kids aren’t as likely to just eat them as candy and use up the entire bag before I can even get to them.
And then because I have a history of asthma as well, I have been using my albuterol inhaler and I always use a spacer on it. And then if you don’t want to use Neti Pot, they also have a nasal spray version of a Neti Pot.
This one I find it a lot harder to use, even though this one’s like really disturbing, pouring something in one nostril and it coming out the other. It’s really disturbing but the feeling after is so fantastic because you can actually breathe.
So those are the products I recommend Instead as a board certified clinical pharmacist and I do not recommend using steroids while you have sinus infections. And if you decide that the sinus infection is so awful, that you think it’s worth it to you to get just a tiny bit of benefit, then go for it. And you can use these all in combination with it. Although I would recommend avoiding ibuprofen in combination with any steroid.
How to use Medrol Dosepak?
But if you do choose to use a Medrol Dosepak while you have a respiratory tract infection, then let me show you how to use it properly. Medrol Dosepak is pretty funny because they have two sets of instructions. They have the instructions right here and they have the instructions right here and they don’t match. One of them says to take two bed for breakfast and then one at lunch and dinner and bedtime.
Don’t do that. Follow these instructions below that say to take the whole day’s dose all at once first thing in the morning. Don’t separate them out, just take them all at once. First thing in the morning that mimics your body’s natural cortisol and is going to minimize your risk for side effects like insomnia.
If you still are struggling with prednisone or you have chronic sinusitis and you’re stuck on prednisone, you should definitely download my Prednisone checklist. It has the top mistakes people make and what you can do about it. Signing off is Dr. Megan, your Prednisone pharmacist.
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