Peter has a nasty sinus infection but is allergic to penicillin. Which alternative medication should his physician prescribe: sulfamethoxazole or itraconazole? Why?

by Maria
(United States)

Peter has a nasty sinus infection but is allergic to penicillin. Therefore, his physician prescribes an alternative. Would you expect his physician to prescribe sulfamethoxazole or itraconazole? Why?

Comments for Peter has a nasty sinus infection but is allergic to penicillin. Which alternative medication should his physician prescribe: sulfamethoxazole or itraconazole? Why?

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by: David

Well, to begin with, not all sinus infections are caused by bacteria. Antibiotics are often indicated when bacteria causes an infection. When a virus is the cause of a sinus infection, having an antibiotic prescribed will not do any good.

According to some medical studies, patients who received no antibiotics for their sinus infection recovered at the same rate as those who did receive an antibiotic. So the clinical findings are mixed in this regard.

Many physicians and prescribers avoid prescribing antibiotics due to the fact that patients develop antibiotic resistance and end up worse off than not taking anything.

According to Harvard Health Publishing at Harvard Medical School, "People with a penicillin allergy on their medical record are not given penicillins, and may not be given any beta-lactam antibiotics because of concern that the allergy is shared across the antibiotic class. Instead, the antibiotics prescribed may be broader-spectrum."

https://www.health.harvard.edu/blog/do-you-really-have-a-penicillin-allergy-2019022616017

According to the writers at rxlist.com, "Augmentin and Bactrim are different types of antibiotics. Augmentin is a combination penicillin-type antibiotic and a beta-lactamase inhibitor and Bactrim is a combination of an anti-bacterial sulfonamide (a "sulfa" drug) and a folic acid inhibitor."

https://www.rxlist.com/augmentin_vs_bactrim/drugs-condition.htm

Itraconazole would typically only be prescribed in the case of allergic fungal sinusitis.

According to a medical study on Itraconazole in this context, the findings indicated, "Oral itraconazole may be of benefit to those patients with recalcitrant fungal sinusitis who have failed maximal medical and surgical therapy. Itraconazole may prolong the time to next recurrence and may enable the patient to significantly decrease or stop oral steroids."

https://www.ncbi.nlm.nih.gov/pubmed/19490806

So the long-winded answer to your question is that the provider would most likely not prescribe itraconazole unless it was for allergic fungal sinusitis. And the provider might only prescribe Sulfatrim when the allergy to penicillin is only mild. Sulfatrim is a penicillin-like antibiotic. So it depends on the severity of the penicillin allergy as to if the provider gives the patient Sulfatrim. But the patient is most likely not getting itraconazole.

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