Antibiotics can be administered in different ways. The most common way to prescribe an antibiotic is orally. But in patients with recurring disease, there are many physicians who give antibiotics intravenously as an outpatient procedure. Antibiotics can also be administered topically via nebulizer, spray, or irrigation preparations. In my experience, topical antibiotics work best in patients who have already undergone sinus surgery. In patients who have not had surgery, the areas to which such antibiotics need to be applied are either partially or totally inaccessible. The bacteria in those areas will thus get suboptimal treatment and are more likely to develop resistance.
Some oral antibiotics deliver the same concentration of drug that their intravenous forms are able to provide. However, this is not true for
all antibiotics. Many physicians still believe, and they may be correct, that intravenous antibiotics always deliver a more reliable drug dose. Regardless of how the antibiotic is taken, the appropriate drug concentration needs to be reached in the bloodstream to achieve results. In any case, I generally use intravenous antibiotics when:
■ The patient experiences stomach upset when taking oral antibiotics
■ Higher blood levels than can be achieved with the oral antibiotic are desired
■ The bacterial infection is not responding to oral antibiotics despite culture sensitivity
■ When the patient suffers from a complication of the sinus infection, including periorbital infection (swelling around the eye, or cellulitis), bulging eyes (proptosis), meningitis, or an eye or brain abscess
■ Surgery reveals significant infection in the underlying bone of the sinuses