A 28-Year-Old Man Comes to the Office Asking for Antibiotics

A 28-year-old man comes to the office asking for antibiotics to treat a "sinus infection."  He reports recurrent episodes of nasal congestion, rhinorrhea, and dry cough.  The patient has used over-the-counter allergy medicines with some relief but continues to feel uncomfortable and has difficulty concentrating at work.  He does not have shortness of breath, chest pain, or ocular symptoms.  The patient has no prior history of allergies or asthma but had eczema during childhood.  He does not use tobacco, alcohol, or illicit drugs.  His temperature is 37 C (98.6 F) , blood pressure is 120/78 mm Hg, and pulse is 76/min.  Physical examination shows a transverse nasal crease, swollen and pale nasal turbinates, and a clear nasal discharge.  There is no maxillary sinus tenderness.  The posterior pharyngeal wall has a "cobblestone" appearance.  Breath sounds are normal with no added sounds.  Which of the following is the most effective therapy for this patient's condition?

A) Inhaled beta agonist
B) Intranasal decongestant
C) Intranasal glucocorticoid
D) Oral antibiotics
E) Oral leukotriene modifier

Correct Answer:

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