“Antibiotic for sinusitis in pregnancy when allergic to PCN”
I was diagnosed with Covid two weeks ago and have had intense sinus congestion. I am 28 weeks pregnant. Five days ago sinus congestion worsen and mild pain over bilateral checks began. Mucus is thick and copious and sinus congestion intense. I even think for a few days at worsening of sinuses had some new body aches. I don’t have a known allergy to penicillin but am very afraid to take PCN drugs. I typically erupt with mild rash to many past antibiotics several days into Tempe course (clarithromycin, macrobid, gentamicin, doxycycline , bactrim_ that rash was pretty intense head to toe after just a couple of doses). Do I have another option outside augmentin which my OB called in for me on Friday. I have not started. The last few antibiotics I have started I have had a panic attack so this is a pretty intense fear with me. I am doing netti pot several times a day and have added vitamin c, zinc, and NAC to prenatal and Afrin at bedtime and a couple of doses of Tylenol a day. I do have a few lorazepam and taken a couple in hope to start the antibiotic but alas keep deferring starting. I have a history of one other sinus infection about 7 years ago and that is when I took Clarithromycin. Thank you.
Female | 41 years old
Complaint duration: 2 weeks
Conditions: Pregnancy, major anxiety otherwise healthy
1 Answer
Augmentin may be harsh on the GI tract and can cause a pretty bad rash in those who may be penicillin allergic, so I would recommend a simple 5 day low-dose course of azithromycin 250mg orally with food daily instead, since you have had a sinus infection for only a short time. However, you do need to be aware that azithromycin is also in the macrolide family of antibiotics so if you had a rash with clarithromycin in the past then it could potentially happen with azithromycin as well. The 250mg daily dose is low though, and not as strong as the full clarithromycin dose so if the rash is very mild, it is worth trying (some hydrocortisone cream can ease the itching of a mild allergic rash in addition to an antihistamine). The sinus rinsing helps tremendously and in the 3rd trimester you can add a nasal steroid spray such as Nasonex for Flonase for reduction of mucosal inflammation in the nose and sinuses. It is normal for you to experience significant nasal congestion especially in the 3rd trimester of pregnancy when estrogen levels are high (even I had it too!). Hope that helps.
