Sinusitis and postnasal drip have always been slow to respond to systemic antibiotics. This is primarily because antibiotics penetrate poorly into diseased sinus cavities. Think of it as trying to get ink into the center of an onion. Unless you soak that onion in a sea of ink, little of the ink will penetrate into the inside.
It is important on any medication or antibiotic to be careful of the dosage. It takes a huge amount of trial and studies to finally come up with a dosage that is SAFE. Once you do find a safe dose, then you need clinical trials to find out if the drug is effective. Then you need trials to see if the new drug is more effective than a placebo. You can understand how difficult this all is when the new drug is effective in 88% of sinus infections, and the placebo is just as effective in 74%.
For most drugs, you only need one week of the medication for lung or kidney infection; but for the sinus infection you need to take the drug for several weeks of longer. For the lung, it is like dropping ink on a blotting paper due to the great circulation to the lung. For the Sinus, it is like dropping ink on an onion. It may take weeks to get to the center of that onion. In other words, clearing a sinus condition with oral antibiotics is difficult if there is built up tissue or disease in the sinus cavity.
This is why doctors now apply the antibiotic by pulsatile irrigation. The advantages are many:
You can use a higher concentrated dose of the medication, since it is not entering the body. Little if any of the drug is absorbed into the body You can use antibiotics that are only effective for topical use You don't need to worry about side effects of the drug because little or none of it enters the body. The medication enters the sinus cavity and remains there to do its work. You can take an X Ray and see the medication inside the sinus cavity. Because of the steady stream with nasal irrigation, plus the pulsation effect, you get maximum entry of the antibiotic solutioin into the infected sinus cavity.
On the negative side, it is important that the instructions be followed carefully for best effect.
Directions for using medication for pulsatile irrigation.
Add warm water to the top of the mark- 500 cc. Add one teaspoon of salt to make a 1% isotonic solution Mix Irrigate 300 cc., about ½ on each side. Then stop and gently clear the nose. This is to remove products that may impede the antibiotic entering the tissues. Now add the doctor's medication to the remaining 200 cc. Mix Now irrigate approximately one hundred cc on each side. When finished, remain at the sink quietly for 10 minutes. Do not blow the nose Try not to blow the nose for about 2 hours.
It is important is to follow your doctor's instructions. The advantage of pulsatile irrigation is that some doctors might want you to irrigate 150 cc on one side and 50 on the other. Or Irrigate first 400 cc of saline and then add medication to the remaining 100 cc.
The types of medication vary depending on culture, patient history, etc. Currently there is a wide variation on medications that are being used, including Gentamycin, Tobramycin, Mupiricin, and many others. The pharmacy companies usually include the pulsatile irrigator with the medication.
Another disadvantage of this method is that some medications occasionally have a taste you may not care for, unlike the simple capsules you can swallow. But considering how effective this method is, and that you spare the patient the unpleasant side effects of the systemic antibiotic, that is not a significant problem.
In summary, when you have an eye infection, you put in eye drops. Now, for sinus infection, you similarly put the antibiotic directly into the sinus cavity by pulsatile irrigation.
