What are the symptoms and treatment options for sinusitis (sinus infection)?

From the Guidelines

For patients with sinus infections, it is recommended to start with nasal saline rinses and over-the-counter decongestants for 3-5 days, and consider antibiotics like amoxicillin or amoxicillin-clavulanate only if symptoms persist beyond 7-10 days or are severe, as most cases are viral and resolve without antibiotics 1. When treating sinus infections, it's essential to distinguish between viral and bacterial causes, as this affects treatment decisions. According to the evidence, most cases of sinusitis (about 90%) are viral and resolve without antibiotics 1.

Key Treatment Considerations

• For mild cases, nasal saline rinses twice daily and over-the-counter decongestants like pseudoephedrine (Sudafed) for 3-5 days can help reduce swelling and manage symptoms.
• Pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil) can help manage discomfort.
• If symptoms persist beyond 7-10 days or include high fever, severe facial pain, or thick green/yellow discharge, antibiotics like amoxicillin (500mg three times daily for 5-7 days) or amoxicillin-clavulanate (875mg twice daily for 5-7 days) may be necessary 1.

Additional Recommendations

• During recovery, staying hydrated, using a humidifier, applying warm compresses to the face, and elevating the head while sleeping can help alleviate symptoms.
• Chronic sinusitis (lasting over 12 weeks) may require evaluation by an ENT specialist.
• It's crucial to note that adjunctive treatments like analgesics, decongestants, corticosteroids, saline irrigation, and mucolytics may aid in symptomatic relief, but their efficacy is not universally proven, and they should be considered on an individualized basis 1.

From the FDA Drug Label

1. 4 Acute Bacterial Sinusitis: 5 Day and 10 to 14 Day Treatment Regimens Levofloxacin tablets are indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis To evaluate the safety and efficacy of a high dose short course of levofloxacin, 780 outpatient adults with clinically and radiologically determined acute bacterial sinusitis were evaluated in a double-blind, randomized, prospective, multicenter study comparing levofloxacin 750 mg by mouth once daily for five days to levofloxacin 500 mg by mouth once daily for 10 days Clinical success rates (defined as complete or partial resolution of the pre-treatment signs and symptoms of ABS to such an extent that no further antibiotic treatment was deemed necessary) in the microbiologically evaluable population were 91.4% (139/152) in the levofloxacin 750 mg group and 88.6% (132/149) in the levofloxacin 500 mg group at the test-of-cure (TOC) visit (95% CI [-4. 2,10] for levofloxacin 750 mg minus levofloxacin 500 mg)

Levofloxacin is effective for the treatment of acute bacterial sinusitis.

• The clinical success rates for levofloxacin 750 mg and 500 mg were 91.4% and 88.6%, respectively.
• The treatment is indicated for acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis 2.

From the Research

Definition and Classification of Sinus Infection

• Acute sinusitis is defined pathologically as transient inflammation of the mucosal lining of the paranasal sinuses lasting less than 4 weeks 3
• Clinically, it is characterized by nasal congestion, rhinorrhoea, facial pain, hyposmia, sneezing, and, if more severe, additional malaise and fever 3
• There are three clinical presentations of acute sinusitis: onset with persistent symptoms, onset with severe symptoms, and onset with worsening symptoms 4

Causes and Prevalence of Sinus Infection

• The predominant bacterial species implicated in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in children 4
• Acute sinusitis affects 1% to 5% of the adult population each year in Europe 3
• There has been an increasing prevalence of penicillin-resistant S. pneumoniae, and beta-lactamase-producing H. influenzae and M. catarrhalis in the last decade 4

Diagnosis and Treatment of Sinus Infection

• Images to confirm the presence of acute sinusitis are necessary in older children (> 6 years) and adults to enhance the certainty of diagnosis 4
• Therapy may be initiated with high-dose amoxicillin or amoxicillin-clavulanate, with alternatives including cefuroxime, cefpodoxime, or cefdinir 4
• In cases of serious drug allergy, clarithromycin or azithromycin may be prescribed 4
• The optimal duration of therapy is unknown, but some recommend treatment until the patient becomes free of symptoms and then for an additional 7 days 4

Management Strategies and Interventions

• A systematic review found 19 systematic reviews, RCTs, or observational studies that met the inclusion criteria for the effectiveness and safety of interventions for acute sinusitis, including antibiotics, antihistamines, decongestants, saline nasal washes, steam inhalation, and topical corticosteroids 3
• Pseudoephedrine is a drug that can be used to treat symptoms of sinusitis, but it also has risks and benefits, including its potential for misuse as a central nervous system stimulant 5