Smoking and sinus infections

Sinus infections cause inflammation or swelling of the sinuses, usually as a result of viruses and bacteria. Smoking can cause the cilia — the hair-like structures that clear microbes and debris from the nose, sinuses, and lungs — to stop working. This may lead to infections such as sinusitis.

The sinuses are the empty spaces behind the forehead and cheekbones. They have various functions, such as protecting the skull in case of injury, keeping bacteria at bay, and allowing mucus to drain.

According to the Centers for Disease Control and Prevention (CDC), several factors, including smoking and exposure to secondhand smoke, can increase the risk of developing a sinus infection.

This article will explain whether smoking can cause sinus infections. It will also explain the symptoms of a sinus infection and how smoking can affect nose health.

A sinus infection is a condition that causes swelling of the sinuses. Doctors also call it sinusitis or rhinosinusitis. Sinusitis is a common viral, bacterial, or fungal infection.

Smoking can lead to sinus infections because smoke is a common irritant. Microscopic hair-like structures called cilia line the nasal cavities. Cilia move along the nasal cavity alongside mucus that traps debris and microbes, preventing infections.

If the cilia stop working or become immobilized, a person may become predisposed to infections. Damage to the cilia in the nasal cavity can result from:

• allergens
• irritants such as smoke, secondhand smoke, animal dander, pollution, and dust
• viruses
• fungi
• bacteria

Other possible causes of a sinus infection include previous colds, seasonal allergies, and a weak immune system.

Sinus infections can be either acute or chronic. An acute sinus infection may be part of a cold and last only a few days. A chronic sinus infection can last more than 8 weeks.

Symptoms of a sinus infection

Symptoms of a sinus infection include:

• stuffy, blocked nose resulting from swelling of the nasal passages
• nasal discharge, which is usually cloudy, green or yellow, or tinged with blood
• runny nose
• throbbing headache
• facial pressure and pain, particularly around the eyes, forehead, and nose
• postnasal drip, which is mucus dripping down the throat
• sore throat
• cough
• bad breath

Most sinus infections get better without treatment.

Read about sinus infections here.

Cigarettes contain various toxic or poisonous substances such as tar, formaldehyde, arsenic, and benzene. As part of the respiratory system’s defense against pathogens and pollutants, the cilia transport debris, microbes, and other dangerous materials out of the airways.

The toxic substances in cigarette smoke can damage the cilia, leading to mucus buildup and delayed clearance. Over time, this can lead to bacteria buildup and, eventually, infections.

Smoking also harms the sinuses by:

• impairing the tissue in the nasal cavity
• diminishing cough reflex sensitivity
• causing persistent damage to DNA, which can result in mutations and lack of repair
• inducing cell death

Why is smoking bad for you?

Long-term effects of smoking on the nose can include:

• structural and functional changes in the respiratory system
• inflammation
• obstruction of the airways
• defects in the immune system
• chronic dysfunction
• tissue repair problems

Chronic sinusitis

Chronic sinusitis is a sinus infection that lasts longer than 8 weeks. Exposure to irritants such as smoking and secondhand cigarette smoke may contribute to the development of chronic sinusitis.

Other types of sinusitis are viral, bacterial, and allergic.

Read more about chronic sinusitis.

Nasal cancer

According to the American Cancer Society, smoking increases the risk of nasal and paranasal sinus cancers.

Smoking may damage the DNA of the cells that line the nasal cavity.

Quitting smoking can significantly affect overall health, including the health of the nose and nasal cavity.

A 2016 study found that quitting smoking improved mucus clearance ability in 33 participants with a median smoking history of 34 years. However, the study had some limitations, including its small sample size.

When a person quits smoking, the cilia in the nasal cavity will regenerate. This is an indication that the body is healing. It may take years, however.

When a person is quitting smoking, they may experience symptoms of nicotine withdrawal, including a runny nose.

According to the CDC, on average, people who smoke die 10 years earlier than those who do not. There are many benefits to quitting smoking, including improving overall health.

The health benefits of quitting smoking can begin the minute a person stops and continue over time.

The benefits of quitting smoking can include:

• reducing the risk of premature death and improving life expectancy
• improving quality of life
• reducing the risk of various health conditions, such as cardiovascular disease and chronic obstructive pulmonary disease
• reducing the risk of 12 types of cancer, including lung cancer
• reducing the overall financial burden of smoking
• reducing inflammation in the body
• reducing the risk of stroke
• reducing respiratory symptoms

Quitting smoking can be of great benefit for a person at any age, no matter how long they have smoked.

Read more about what happens when you quit smoking here.

Although quitting smoking can be challenging, with the right approach, it is possible to break the habit. A person may find the following methods helpful:

• nicotine replacement therapies, such as:
  • gum
  • lozenges
  • patches
  • inhalers
  • nasal sprays
• medications such as varenicline and bupropion
• counseling services that can help a person make a plan to quit and cope with withdrawal symptoms when quitting
• free resources and programs, such as those from the CDC

Read our tips on ways to quit smoking here.

Smoking can contribute to sinus infections because the toxins in cigarettes can damage the cilia in the nasal cavity. Cilia ensure that the nose, lungs, and sinuses are free of pathogens and mucus — without them, infections such as sinusitis are more likely to happen.

Smoking can affect a person’s overall health in various ways. No matter how long someone has smoked, quitting can provide various health benefits, including reducing the risk of serious health conditions and premature death.

Smoking and sinus infections

Sinus infections cause inflammation or swelling of the sinuses, usually as a result of viruses and bacteria. Smoking can cause the cilia — the hair-like structures that clear microbes and debris from the nose, sinuses, and lungs — to stop working. This may lead to infections such as sinusitis.

The sinuses are the empty spaces behind the forehead and cheekbones. They have various functions, such as protecting the skull in case of injury, keeping bacteria at bay, and allowing mucus to drain.

According to the Centers for Disease Control and Prevention (CDC), several factors, including smoking and exposure to secondhand smoke, can increase the risk of developing a sinus infection.

This article will explain whether smoking can cause sinus infections. It will also explain the symptoms of a sinus infection and how smoking can affect nose health.

A sinus infection is a condition that causes swelling of the sinuses. Doctors also call it sinusitis or rhinosinusitis. Sinusitis is a common viral, bacterial, or fungal infection.

Smoking can lead to sinus infections because smoke is a common irritant. Microscopic hair-like structures called cilia line the nasal cavities. Cilia move along the nasal cavity alongside mucus that traps debris and microbes, preventing infections.

If the cilia stop working or become immobilized, a person may become predisposed to infections. Damage to the cilia in the nasal cavity can result from:

• allergens
• irritants such as smoke, secondhand smoke, animal dander, pollution, and dust
• viruses
• fungi
• bacteria

Other possible causes of a sinus infection include previous colds, seasonal allergies, and a weak immune system.

Sinus infections can be either acute or chronic. An acute sinus infection may be part of a cold and last only a few days. A chronic sinus infection can last more than 8 weeks.

Symptoms of a sinus infection

Symptoms of a sinus infection include:

• stuffy, blocked nose resulting from swelling of the nasal passages
• nasal discharge, which is usually cloudy, green or yellow, or tinged with blood
• runny nose
• throbbing headache
• facial pressure and pain, particularly around the eyes, forehead, and nose
• postnasal drip, which is mucus dripping down the throat
• sore throat
• cough
• bad breath

Most sinus infections get better without treatment.

Read about sinus infections here.

Cigarettes contain various toxic or poisonous substances such as tar, formaldehyde, arsenic, and benzene. As part of the respiratory system’s defense against pathogens and pollutants, the cilia transport debris, microbes, and other dangerous materials out of the airways.

The toxic substances in cigarette smoke can damage the cilia, leading to mucus buildup and delayed clearance. Over time, this can lead to bacteria buildup and, eventually, infections.

Smoking also harms the sinuses by:

• impairing the tissue in the nasal cavity
• diminishing cough reflex sensitivity
• causing persistent damage to DNA, which can result in mutations and lack of repair
• inducing cell death

Why is smoking bad for you?

Long-term effects of smoking on the nose can include:

• structural and functional changes in the respiratory system
• inflammation
• obstruction of the airways
• defects in the immune system
• chronic dysfunction
• tissue repair problems

Chronic sinusitis

Chronic sinusitis is a sinus infection that lasts longer than 8 weeks. Exposure to irritants such as smoking and secondhand cigarette smoke may contribute to the development of chronic sinusitis.

Other types of sinusitis are viral, bacterial, and allergic.

Read more about chronic sinusitis.

Nasal cancer

According to the American Cancer Society, smoking increases the risk of nasal and paranasal sinus cancers.

Smoking may damage the DNA of the cells that line the nasal cavity.

Quitting smoking can significantly affect overall health, including the health of the nose and nasal cavity.

A 2016 study found that quitting smoking improved mucus clearance ability in 33 participants with a median smoking history of 34 years. However, the study had some limitations, including its small sample size.

When a person quits smoking, the cilia in the nasal cavity will regenerate. This is an indication that the body is healing. It may take years, however.

When a person is quitting smoking, they may experience symptoms of nicotine withdrawal, including a runny nose.

According to the CDC, on average, people who smoke die 10 years earlier than those who do not. There are many benefits to quitting smoking, including improving overall health.

The health benefits of quitting smoking can begin the minute a person stops and continue over time.

The benefits of quitting smoking can include:

• reducing the risk of premature death and improving life expectancy
• improving quality of life
• reducing the risk of various health conditions, such as cardiovascular disease and chronic obstructive pulmonary disease
• reducing the risk of 12 types of cancer, including lung cancer
• reducing the overall financial burden of smoking
• reducing inflammation in the body
• reducing the risk of stroke
• reducing respiratory symptoms

Quitting smoking can be of great benefit for a person at any age, no matter how long they have smoked.

Read more about what happens when you quit smoking here.

Although quitting smoking can be challenging, with the right approach, it is possible to break the habit. A person may find the following methods helpful:

• nicotine replacement therapies, such as:
  • gum
  • lozenges
  • patches
  • inhalers
  • nasal sprays
• medications such as varenicline and bupropion
• counseling services that can help a person make a plan to quit and cope with withdrawal symptoms when quitting
• free resources and programs, such as those from the CDC

Read our tips on ways to quit smoking here.

Smoking can contribute to sinus infections because the toxins in cigarettes can damage the cilia in the nasal cavity. Cilia ensure that the nose, lungs, and sinuses are free of pathogens and mucus — without them, infections such as sinusitis are more likely to happen.

Smoking can affect a person’s overall health in various ways. No matter how long someone has smoked, quitting can provide various health benefits, including reducing the risk of serious health conditions and premature death.

Sinusitis (sinusitis) – symptoms, causes, treatment

What is sinusitis and why is it called sinusitis?

Sinusitis is an inflammation of one or more of the paranasal sinuses. Most often, the maxillary sinuses, which were previously called the maxillary sinuses, become inflamed. This is called in everyday life sinusitis. It usually occurs as a complication of rhinitis (runny nose), flu, with a dental infection of the roots of the upper teeth. Bacteria or viruses enter the maxillary cavity and cause inflammation.

Risk factors for sinusitis

Impaired outflow of mucus from the maxillary sinuses, for example, as a result of nasal polyps, deviated nasal septum; frequent SARS; smoking; allergy; cystic fibrosis; immunodeficiencies (for example, HIV).

Symptoms of sinusitis

• Nasal stuffiness;
• drawing pain and feeling of fullness, pressure in the bridge of the nose, temples, under the eyes, especially when bending the body forward;
• pain in the upper jaw, teeth;
• headache, decreased performance, fatigue;
• cough, especially at night;
• in combination with the following symptoms: bad breath, loss of smell, fever (usually up to 37-38 degrees).

When to go to the doctor?

You need medical help if:

• your symptoms are very bothersome and last more than 3 days or get worse;
• you have a persistent high temperature;
• you have been diagnosed with chronic sinusitis.

Causes of sinusitis

Sinusitis can be:

• infectious or allergic;
• viral or bacterial.

Possible complications

Complications are rare in sinusitis. They may be:

• chronic sinusitis lasting more than 12 weeks;
• frontal sinusitis (inflammation of the frontal sinus), meningitis;
• inflammation of the bones of the skull – osteomyelitis;
• problems with vision, hearing, loss of smell.

How to prevent sinusitis?

• Keep allergies under control.
• Less likely to catch a cold (harden, keep the immune system in shape, wash hands more often).
• Do not smoke or breathe tobacco smoke.
• Moisturize the air in the apartment, because when the air is dry, the mucus becomes more viscous and it is more difficult to remove it from the sinuses.

Diagnosis of sinusitis

In addition to examining and recording symptoms, any suspected sinusitis requires x-ray examination of the paranasal sinuses. In chronic sinusitis, all adjacent tissues are additionally examined using computed tomography to identify the cause of frequent exacerbations: polyps, tumors, a foreign body in the nose, etc. Sometimes a blood test may be needed to distinguish viral from bacterial sinusitis.

In our clinic, you can take all the necessary tests right at the time of your appointment, as well as take an X-ray.

About clinic

Euromed Clinic is a multidisciplinary family clinic in the center of St. Petersburg.

• Doctor’s house calls
• 24-hour therapist appointment
• Tests, ultrasound, X-ray
• Diagnostics of the whole body
• Hospital and surgery
• Vaccination

Learn more about the clinic

Treatment of sinusitis

Treatment of sinusitis depends on its origin. Antihistamines are prescribed for allergic sinusitis, antibiotics for bacterial sinusitis. Vasoconstrictor drugs may be prescribed to relieve symptoms. Sinus lavages are used, the so-called “cuckoo”. In some cases, a sinus puncture is required to remove pus, flush out the sinus, and possibly inject medication into it.

Home treatment

Never warm up the nose in case of acute sinusitis!

You can master rinsing your nose with salt water, and acute sinusitis will most likely stop bothering you after 1-2 days. This rinsing is especially useful if you have a deviated nasal septum.

Other sinusitis

Frontitis – inflammation of the frontal sinus – is less common than sinusitis. Frontitis can develop with a nose injury, severe flu. The main symptom is severe pain and swelling in the forehead, photophobia. This is a severe lesion, the outcome of which may be bone necrosis, brain abscess, meningitis.
Even less often, inflammation of the ethmoid and sphenoid sinuses (ethmoiditis, sphenoiditis) is possible. They usually occur simultaneously with sinusitis and frontal sinusitis, for example, with scarlet fever. These sinusitis are usually treated in a hospital.

You can sign up for a consultation by phone: + 7 812 327 03 01.

evolution from SARS to acute bacterial sinusitis

00:00

Vladimir Trofimovich Ivashkin , Academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences:

– Now we turn to the issues of otoringology. Professor Valery Mikhailovich Svistushkin will make a report on the infection of the nose and paranasal sinuses.

Valery Mikhailovich Svistushkin , professor:

– Good afternoon, dear colleagues and dear Vladimir Trofimovich.

Today we are talking about an urgent problem in this transitional period. Although the problem of acute respiratory diseases (ARI) is relevant throughout the year. In this or that period, certain viruses, bacterial agents matter, come out on top.

I would like to start with a seemingly rhetorical question: what is it better to die from? The answer to it may be very different. One of the answers, which, perhaps, will greatly satisfy us. From those reasons when we can leave this world as late as possible.

At 74, most Europeans reach their peak of happiness. Their happy period begins at the age of 46. Sociological surveys of residents of European countries.

What do we have. Unfortunately, things are not so optimistic. We are lagging behind in almost every respect. This is an otorhinolaryngologist, so we are primarily talking about the upper respiratory tract. The difference between us and Western countries is palpable.

There are indeed problems. These problems are relevant for all countries. In particular, for Russia. I tried to formulate the problems of acute respiratory infections that have accumulated in our country by this year.

High incidence in general. We probably won’t talk about the famous H1N1 (swine flu) pandemic today. Fortunately, it is over (according to WHO experts). Although the virus, as you know, has not gone away. According to many infectious disease specialists, it will circulate for a long time as a seasonal, epidemic virus.

Restriction of the possibility of virological diagnostics. In our practice, it is not so easy to assess which particular virus causes a particular disease. The complexity of the selection of etiotropic therapy. Rising resistance to basic antiviral drugs. It should be emphasized that resistance is growing not only to antibiotics. It is very actively growing and to antiviral drugs.

Emphasis on symptomatic therapy, self-treatment. Insufficient use of pathogenetic therapy. Whatever inflammation we are talking about – viral or bacterial – it is inflammation. It is necessary from this point of view to use pathogenetic treatment.

Another very serious problem is the use of drugs with unproven efficacy. Polypharmacy, problems of prevention. We could talk and discuss each problem for a very long time today. The format of this broadcast does not allow this, so I will allow myself to dwell on some of the most pressing issues, in my opinion.

03:21

If we are talking about specific viruses. Data may be different for different regions, cities. Data from St. Petersburg, where the largest percentage falls on rhinoviruses. A large percentage of adenoviruses. Coronaviruses – somewhere more, somewhere less.

If we are talking about Moscow and the past epidemiological season, then there may be adenoviruses, RS viruses, parainfluenza virus. It does not matter which viruses cause this or that disease (although this is also, of course, important), because we do not have so many etiotropic drugs for each of these viruses.

But in general I would like to emphasize the upper respiratory tract. The percentage of damage to the upper respiratory tract in any acute respiratory disease, in particular with viral pathology, is high. In any age category, it is the upper respiratory tract that primarily responds to the effects of a microbial agent.

This is especially true for the common cold, sinusitis. The data that we received not so long ago is very important. They show that sinusitis has already taken place in almost any acute respiratory disease. It is almost always available.

Another thing is viral sinusitis. He is catarrhal, but he is already there. Where is the step to the development of bacterial inflammation. It may be very small. Then it is a purulent process. Special situation in treatment. Participation of an otolaryngologist. For 80 – 90% of viral infections, these are patients who come to therapists, general practitioners, family doctors. including otolaryngologists.

05:18

How is it that the virus enters the nasal cavity, the sinuses. You can follow this chain. The nasal cavity is the first barrier the virus encounters. How this first barrier works will determine how much a systemic disease develops, how much general processes will be expressed. Or will there still be a more or less local situation in the form of acute rhino-sinusitis.

Reproduction of viruses, their replication, cytopathic effect, destruction of ciliary cells. The cells lose their cilia. The mucous membrane becomes bald (as we say). There is a situation resembling a worn carpet. Eyelashes are removed.

Further inflammatory mediators, cell death. Clinical picture in expanded version. Everything will depend on how competently we carry out the treatment, how adequately the immune system works. Either this is a recovery, or a transition to a chronic form.

Here I would like to return, perhaps, to the main defense mechanism of this section of the respiratory tract. This is mucociliary transport (MCT). Famous lashes. Only a 16% reduction in the frequency of beating cilia (CBR), and how much reduced the transport of mucus.

Eyelashes were supposed to “start up” with us today. But, unfortunately, we will not be able to see this beauty of the famous picture. The beat frequency is 700 – 800 beats per minute. This is the norm.

A lot of factors affect the NBR.

(Slide show).

This is how the mucous membrane looks on the background of the development of a viral infection. Moment of baldness, loss of cilia. Hypersecretion. A large number of secretory cells.

This is quite a lengthy process. The third day of the disease – the same bald mucous membrane. Only on the 7-8th day cilia begin to form. The moment of completion of the rehabilitation of the mucosa occurs by the end of the second week. At this point, the mucosa becomes defenseless. Mucus accumulates here, its outflow is disturbed. Conditions arise for the development of attachment and bacterial flora. This step from catarrhal inflammation to the development of a purulent process is born here.

Although sinusitis is affected by many factors. Anatomical features (deformities of the nasal septum, enlarged turbinates). Definitely an allergy. The influence of the allergic process on the development of sinusitis is 25 – 70%. Smoking triggers. We can talk a lot about this, argue. But you can’t get away from it. Development of chronic rhinitis and factors that influence the development of sinusitis.

08:38

Very nice picture. It clearly shows how passive smoking affects our body. The death grip in the larynx has already worked at the level of the nasal cavity and paranasal sinuses. It seems to me that the slogan of the French anti-smoking league is very successful:

“Everyone can smoke as much as they want. Even if he dies from it, he must not interfere with others with his smoke.”

Back to bacterial processes. The main source of bacterial infection is the microflora of the nasal passages. Then one or another microorganism.

A study that evaluates how bacterial levels have changed lately tells us that beta-haemolytic streptococci are moving into second or third position. Haemophilus influenzae, M. Catarrhalis and streptococcus with pneumonia are on the first places. This data is not only ours, but also our Western colleagues. Streptococcus with pneumonia, M. Catarrhalis, hemophilic bacterium – those microorganisms that are leading in the development of a purulent process.

Everything is not so simple. Studies of recent years, performed in closed groups, have shown that Haemophilus influenzae has a fairly decent percentage and is ahead of streptococcus with pneumonia. If we talk about atypical flora, then any specialist dealing with the lower respiratory tract will say that up to 30% of community-acquired pneumonia is a typical flora of mycoplasma pneumonia, chlamydophila, and so on.

Otolaryngologists may not appreciate this section of the bacterial flora. We are well aware that we have a single breathing tube. If this problem exists in relation to the lower respiratory tract, then it is also relevant in relation to the upper sections.

10:39

How do we navigate when we talk about catarrhal viral inflammation, when we talk about purulent. The scheme seems to me very simple and quite clear. If during the first five days of development of acute rhinosinusitis we are talking about a viral infection. If there is a surge of symptoms, then there is an attachment of the bacterial flora.

If such a picture persists for 10 days, despite the ongoing treatment, the clinic does not change, then in this situation we can also talk about the development of a bacterial infection. Then we are talking about the addition of systemic antibiotic therapy.

If we talk about severity, then there are also quite clear visual analogue scales that say that we can talk about a bacterial process if the symptoms are more than three points. The patient clearly points to this interval from three to seven. This is still an outpatient situation.

If the symptomatology becomes so violent that it can be assessed as more than seven points, this is a hospital. This is the parenteral route of administration of antibiotics and so on.

What should we do in this situation. WHO recommendations are clear. Whatever the etiological factor is (virus or bacterium), we must carry out etiotropic treatment. With viruses, timely and rapid treatment with antiviral drugs helps to alleviate the whole situation.

Research carried out in Moscow. Professor Kolobukhina Lyudmila Vasilievna showed how much the percentage of complications of a viral infection increases if adequate timely antiviral treatment is not carried out.

With regard to acute rhinosinusitis, this is probably the most relevant, because if the treatment is timely, then in 40-45% of cases we do not bring the case to the use of systemic antibiotics.

The spectrum of antivirals that we currently use most frequently in our practice. Probably, each will be characterized by a problem or several problems in general. It would be possible to discuss this topic for a long time.

13:05

The most critical situation regarding the evidence base. With regard to resistance, it was said that this problem is also very urgent. The most common drug we can talk about a lot is “Tamiflu” (“Tamiflu”). Resistance to it has grown a lot in recent years.

The evidence base is rather ambiguous. For a number of drugs, we do not have randomized trials. Either the value of the effectiveness of drugs is not defined. We can now safely attribute these drugs to drugs that cause a placebo effect.

The most common antiviral drugs, their effectiveness. Not everything is so clear. The most common in our practice are “Ingavirin” (“Ingavirin”) and “Arbidol” (“Arbidol”). These studies show that things are far from clear.

Another problem is the toxicity of antiviral drugs. Not in every case, when we prescribe this or that drug, we think that each of them has a toxic effect to a greater or lesser extent.

Principles of treatment of acute sinusitis. Etiotropic treatment is fundamental here. Many other points: from unloading therapy, elimination therapy. Since this is a viscous mucus, a violation of the mucociliary clearance, it is necessary to use drugs that improve the MCT. This is elimination therapy.

Our Western colleagues give us the situation that antibiotics are inside. If we are talking about the treatment of patients after 5 days, these are intranasal steroids (very popular at the moment).

Briefly about systemic antibiotics. The problems are the same. These are either beta-lactams in an acute situation, or macrolides, or fluoroquinolones. Here, too, everything is not so simple.

According to studies that were conducted in our country, resistance 10 years ago against a group of macrolides. After 10 years, it has grown almost 2-5 times. This is food for thought. It allows us to think about which groups we should use first. Data on streptococci with pneumonia.

15:50

Haemophilus influenzae data. It must be remembered that Haemophilus influenzae is naturally resistant to the group of macrolides. Maybe here to speculate as to whether this is the first line of defense. Resistance against Haemophilus influenzae in a number of modern pathogens is growing.

If we evaluate the spectrum of antibacterial drugs, then we are talking about beta-lactams, macrolides (neomacrolides) and fluoroquinolones. Errors occur.

Data for Moscow. Errors regarding “Lincomycin” is a problem that we have been struggling with for many years. Fortunately, this has become less common. But this problem occurs. She meets in different cities. Or it is a parenteral route of administration of drugs in the treatment of patients of moderate severity. outpatient problem. This is a serious mistake when we talk about the parenteral route of administration.

Or topical antibiotic therapy for patients when systemic antibiotics are required. Almost all recommendations – domestic and our foreign colleagues – are similar in this regard. Beta-lactams, fluoroquinolones as a reserve group drug or macrolides.

Starting therapy and meta-analysis of a very large number of studies show that the first drug (when we talk about the treatment of patients with acute purulent sinusitis) is the penicillin series. More specifically, amino-protected penicillins. Studies show that they are superior to the uncombined form of beta-lactams.

One more point that must be remembered in principle is that in infections associated with Haemophilus influenzae, the microbiological efficacy of amino-protected penicillins is superior to the macrolide group. As we remember from the famous film, amino-protected ones are far from being the same in terms of their bioavailability. The line of flexmoxins is significantly superior to other forms of amino-protected ones.

18:11

Macrolides are naturally resistant to Haemophilus influenzae. If we are talking about atypical flora, then this is probably the first line of defense. In respiratory quinolones, this is a reserve. There are definite advantages. Very wide range of activities. Of course, its disadvantages in the form of side effects. We know them very well.

Resilience is growing. This can be seen with an example. The more often we use certain groups of antibiotics, specific drugs, the resistance to them will increase.

There are many ways to overcome this resistance. The creation of new antibiotics is probably not the right way, because it requires a huge amount of material investment and time.

The development of clavulanic acid-type inhibitors is of some help to us. An increase in a single daily dose – our Western colleagues have such a situation. For example, in American colleagues, the daily dose increases to 3-4 grams per day. But while we have recommendations up to 2 grams. We don’t have the kind of resistance problem that exists in those countries.

Development of new forms of delivery. In this regard, the line of solutabs is very indicative. Such new technologies allow to maximize the absorption of the drug, reduce side effects. Thus, the maximum amount of the drug is in the blood, in the tissues. This bactericidal or bacteriostatic effect also manifests itself.

Research done at home and abroad shows how effective new forms of antibiotics are. This is also associated with a decrease in adverse events, side effects that occur primarily from the gastrointestinal tract. These studies, in my opinion, are very eloquent.

In conclusion, I would like to say that for our country the method of drainage, establishing the outflow of puncture is very relevant. Almost always the puncture is performed. Here one can argue with Western colleagues whether it is necessary or not. One of the best ways to drain.

But we also have modern methods. For example, balloon-catheter sinusotomy. Under the control of endoscopes, a special balloon is inserted into the paranasal sinus, and the natural opening expands. This hole, through which the sinus drains, remains in an expanded state. Next, you can wash the sinus.

A method that has already been registered in Russia since this autumn. We are actively using it. We place great hopes on such a minimally invasive, almost surgical method of treatment.

21:20

We probably won’t show the film today. This is information for our new meetings.

In conclusion, I would like to say that the problem of acute respiratory infections will indeed always be relevant. Including the problem of treatment of acute rhinosinusitis. This is an integrated approach. The use of innovative forms, medications. Of course, new surgical technologies.

Thank you very much.

Vladimir Ivashkin : Thank you very much, Valery Mikhailovich. You have a lot of questions. You will cope with them if you answer very briefly, otherwise it will be the second lecture.

Valery Svistushkin : I will try to be very short. Question from Saratov.

Question: Does resistance to the use of Josamycin vary by geographic region?

Yes, there is such data. In general, such resistance is not expressed, therefore, one of the options for using this drug in the treatment of patients with acute tonsillitis. This is another problem that should, apparently, be considered separately.

Question: Is tonsillectomy currently an issue?

It is always relevant. Was and remains. With the testimony, we both carried it out, and we are doing it. There are modern, new technological methods for treating patients with chronic tonsillitis, but no one has canceled tonsillectomy.

22:38

Question: Is it necessary to immediately prescribe antibiotics to patients with acute respiratory viral infections who have chronic tonsillitis in order to avoid the development of complications?

All the studies that have been conducted here and abroad show that the preventive administration of systemic antibiotics does not reduce the risk of developing bacterial tonsillitis. We start prescribing antiviral drugs in the same way as in the case of viral sinusitis. Next, we evaluate the situation.

Question: Do you recommend the use of macrolides in pediatric practice, especially in diphtheria?

Nobody canceled the macrolide group of antibiotics. But in each case, it is necessary to evaluate which pathogen causes a particular disease.