Nasal infection and rhinosinusitis treatment

[hinterland]

Hi,

I have a nasal infection along with longstanding chronic rhinosinusitis symptoms and inhalant allergies. When I blow my nose I produce dry, crusty, flecks of green snot; and it feels as if the inside of my cheeks (sinus cavity presumably) is coated. There is a feeling of fullness in my inner ears and tinnitus, difficulty hearing and processing conversation, post nasal drip, swollen neck glands and 'shimmering' vision. I generally have dry mucous membranes, skin and hair, and am sensitive to medications and chemicals.

Previously I've got some short term improvement from using nasal Bactroban (Mupirocin) antibiotic ointment, but symptoms recur shortly after completing the 10 day course of treatment. Other strategies that help reduce misery are saline spray and soothing petroleum jelly based nasal ointments like Nisita.

Recently I've had some medical appointments with a new, young, enthusiastic GP, who is willing to try new things with me. His first suggestion was a nasal steroid spray. Of course I've used this before, indeed I was continually using it along with antibiotic Fucidin cream (Fusidic acid) applied inside my nostrils, from ages 14 to 23 . I was reluctant to use the nasal steroid spray as I suspect this might have been involved in the development of my chronic symptoms in the first place, but, on reflection, probably willing to try the standard 6 week course of treatment, combined with Bactroban ointment, initially, while supplies last to try and leverage maximum improvement.

My current question is below (interested to hear your comments and thoughts on this):

The doctor's other suggestion was to combine the Bactroban nasal ointment with Octenisan antibiotic body wash, as they do for pre-surgery MRSA decolonisation treatment of patients, on the supposition that (1) the nasal infection is a staph infection (or other sensitive bacteria?), and (2) the nasal mucosa was becoming recolonised from other body sites.

I'm really not sure about the rational for this proposition, what do you think? I'm not really keen to apply antibiotic wash and disrupt my skin microbiota, just on a fairly speculative basis. I've never heard of this approach being used to try and treat chronic nasal or sinus infections, have you? What do you think? Thanks...

 

[heapsreal]

Hi,

I have a nasal infection along with longstanding chronic rhinosinusitis symptoms and inhalant allergies. When I blow my nose I produce dry, crusty, flecks of green snot; and it feels as if the inside of my cheeks (sinus cavity presumably) is coated. There is a feeling of fullness in my inner ears and tinnitus, difficulty hearing and processing conversation, post nasal drip, swollen neck glands and 'shimmering' vision. I generally have dry mucous membranes, skin and hair, and am sensitive to medications and chemicals.

Previously I've got some short term improvement from using nasal Bactroban (Mupirocin) antibiotic ointment, but symptoms recur shortly after completing the 10 day course of treatment. Other strategies that help reduce misery are saline spray and soothing petroleum jelly based nasal ointments like Nisita.

Recently I've had some medical appointments with a new, young, enthusiastic GP, who is willing to try new things with me. His first suggestion was a nasal steroid spray. Of course I've used this before, indeed I was continually using it along with antibiotic Fucidin cream (Fusidic acid) applied inside my nostrils, from ages 14 to 23 . I was reluctant to use the nasal steroid spray as I suspect this might have been involved in the development of my chronic symptoms in the first place, but, on reflection, probably willing to try the standard 6 week course of treatment, combined with Bactroban ointment, initially, while supplies last to try and leverage maximum improvement.

My current question is below (interested to hear your comments and thoughts on this):

The doctor's other suggestion was to combine the Bactroban nasal ointment with Octenisan antibiotic body wash, as they do for pre-surgery MRSA decolonisation treatment of patients, on the supposition that (1) the nasal infection is a staph infection (or other sensitive bacteria?), and (2) the nasal mucosa was becoming recolonised from other body sites.

I'm really not sure about the rational for this proposition, what do you think? I'm not really keen to apply antibiotic wash and disrupt my skin microbiota, just on a fairly speculative basis. I've never heard of this approach being used to try and treat chronic nasal or sinus infections, have you? What do you think? Thanks...

Just what i have done. Bactroban cream mixed with saline in a nasal spray bottle and sprayed it up there 2-3 times a day while being on oral augmentin has helped me . Plus the regular flushing etc. I use the steroid sprays but not much from them. Got a little benefit from an antihistamine spray. When really blocked a week or so of prednisone which im currently on and does help.

With our immune system sinusitis is like a dam.co-infection.

 

[hinterland]

Just what i have done. Bactroban cream mixed with saline in a nasal spray bottle and sprayed it up there 2-3 times a day while being on oral augmentin has helped me . Plus the regular flushing etc. I use the steroid sprays but not much from them. Got a little benefit from an antihistamine spray. When really blocked a week or so of prednisone which im currently on and does help.

With our immune system sinusitis is like a dam.co-infection.

Thanks very much for your reply, Heapsreal. Sorry, but I'm not quite sure what you mean when you write 'Just what I have done'. So, to clarify, have you combined the Bactroban nasal ointment with Octenisan antibiotic bodywash MRSA decolonisation regime? Or, are you talking about your other treatment protocol, with home-made Bactroban spray and oral antibiotics.

I've been thinking about it some more, and, to me, it doesn't make sense to use an antibiotic bodywash after an infection has been established, as is the case with my nasal/ sinus infection. If you're unfortunate enough to acquire, say, a post-operative MRSA infection in hospital, the treatment protocol doesn't include antibacterial bodywash, does it? So far as I know... Topical and systemic antibiotics, yes. Treat the infected wound, yes absolutely; but decolonise distant sites? No... that's not going to help treat the active infection.

Where the nasal/ sinus infection has recurred in my case, it's more likely because the nasal ointment hasn't penetrated deeply enough into the nasal and surrounding sinus tissue, especially where deeper sinus cavities have become affected. And, fundamentally, a big part of the problem is probably damaged mucous membranes that are no longer providing an effective defence against infection, not to mention the disrupted nasal microbiome. (On that point, are there any effective nasal probiotic products on the market - I must look into that...)

By the way, I'm very curious to hear about how effective the jerry-rigged Bactroban spray was; did it even 'spray'? Hehe. Good on you for trying that out, what ratio of Bactroban cream to saline did you use? Did it mix well?

All the best.

 

[heapsreal]

Thanks very much for your reply, Heapsreal. Sorry, but I'm not quite sure what you mean when you write 'Just what I have done'. So, to clarify, have you combined the Bactroban nasal ointment with Octenisan antibiotic bodywash MRSA decolonisation regime? Or, are you talking about your other treatment protocol, with home-made Bactroban spray and oral antibiotics.

I've been thinking about it some more, and, to me, it doesn't make sense to use an antibiotic bodywash after an infection has been established, as is the case with my nasal/ sinus infection. If you're unfortunate enough to acquire, say, a post-operative MRSA infection in hospital, the treatment protocol doesn't include antibacterial bodywash, does it? So far as I know... Topical and systemic antibiotics, yes. Treat the infected wound, yes absolutely; but decolonise distant sites? No... that's not going to help treat the active infection.

Where the nasal/ sinus infection has recurred in my case, it's more likely because the nasal ointment hasn't penetrated deeply enough into the nasal and surrounding sinus tissue, especially where deeper sinus cavities have become affected. And, fundamentally, a big part of the problem is probably damaged mucous membranes that are no longer providing an effective defence against infection, not to mention the disrupted nasal microbiome. (On that point, are there any effective nasal probiotic products on the market - I must look into that...)

By the way, I'm very curious to hear about how effective the jerry-rigged Bactroban spray was; did it even 'spray'? Hehe. Good on you for trying that out, what ratio of Bactroban cream to saline did you use? Did it mix well?

All the best.

Homemade job but have used the prescription BEG nasal spray, which kept sinusitius away for a few months. I cant say if it was MRSA or not but do work in the health industry so it wouldnt suprise me. My cfs dr at the time said a nasal swabs can be inaccurate for whats in the actual sinuses but commonly its staph in the sinuses.

The home made spray was a 7.5gram bactroban cream not ointment as its hard to mix, in a 20ml spray bottle with saline which i initially warm to help mix. Then i shake well before use. Id do 2 sprays up each nostril 3 times a day. Personally on its own i dont think you get full effects but better than just smearing bactroban in the nostrils. So i think one needs a systemic oral abx such as augmentin or bactrim along with it.

For me the homemade job did help but sinusitis is reoccurring. Im under the impression that in many cfsers that sinusitis is another coinfection that comes and goes and with me im usually neutropenic and have low nk function, which doesnt help the problem. Sinusitis adds another layer of fatigue to cfs, so when bad its worth treating and knocking it back for awhile.

I will add doxycycline can help and have used it long term on occassion and or added to other abx for a double whammy. And just keep up the usual nasal rinsing etc

Thats me in a nutshell. I hope that helps. Good luck. If you have successes with sinuses, make sure to update us all