The original drug regimen with IV antibiotics and topical decongestants
Oral and topical decongestants
are often used as adjuncts to oral antihistamines.
They include: URI, allergic rhinitis, overuse of topical decongestants
, hypertrophied adenoids, deviated nasal septum, nasal polyps, swimming and diving, cigarette smoking, barotrauma, dental extraction/injection, immune deficiency, cystic fibrosis, bronchiectasis, and immotile cilia syndrome (Slavin, 1993).
Rhinitis medicamentosa occurs when topical decongestants
(nasal sprays) are used in excess.
* Topical Decongestants
: Afrin (64% of 1,372 pharmacist recommendations)
Parents must also be advised to avoid unnecessary and potentially harmful therapies, including most over-the-counter (OTC) cough and cold medications and topical decongestants
Rhinitis medicamentosa is a special case, caused by the overuse of topical decongestants
(4) This recommendation is based on the lack of evidence regarding efficacy and the known rebound congestion associated with topical decongestants
. If a decongestant is prescribed, the oral route is preferred, with the understanding of potential significant side effects of nervousness, insomnia, tachycardia, and hypertension.
Finding purulent secretions in the nasal cavity is highly specific for acute bacterial rhinosinusitis (specificity 79%-100%) (1, 2, 3) but is uncommon and difficult to assess, requiring the use of a nasal speculum and possibly topical decongestants
. The primary care physician's overall clinical impression was accurate in Williams' study but not in others.
Medical treatment for chronic rhinosinusitis cases included Antibiotics, Topical steroids, Oral and topical decongestants
, systemic steroids for necessary case and Allergy management.
 Although topical decongestants
are generally not recommended for chronic sinusitis,  our patient experienced symptomatic relief with oxymetazoline during an acute exacerbation.