From the Guidelines
For patients with sinusitis and a penicillin allergy, a suitable alternative treatment is a non-penicillin antibiotic.
Treatment Options
- A recommended option is azithromycin (Zithromax) 500 mg orally once daily for 5 days, or clarithromycin (Biaxin) 500 mg orally twice daily for 7-10 days, or doxycycline (Vibramycin) 100 mg orally twice daily for 7-10 days, as suggested by 1.
- Another option is a fluoroquinolone such as levofloxacin (Levaquin) 500 mg orally once daily for 7-10 days or moxifloxacin (Avelox) 400 mg orally once daily for 7-10 days.
- Folate inhibitors (trimethoprim-sulfamethoxazole) are also a cost-effective alternative to amoxicillin for patients with penicillin allergy, as mentioned in 1.
- The macrolide class of antibiotics may also be used for patients with penicillin allergy, as stated in 1. It's essential to note that the choice of antibiotic should be based on the severity of the sinusitis, local resistance patterns, and patient-specific factors such as renal function and potential drug interactions, as emphasized in 1.
Key Considerations
- The patient's age, general health, cardiopulmonary status, and comorbid conditions should also be considered when deciding on a treatment option, as mentioned in 1.
- Watchful waiting (without antibiotic therapy) may be considered as initial management for patients with uncomplicated ABRS, regardless of severity, as suggested by 1.
- Adjunctive therapy, such as intranasal saline irrigation or intranasal corticosteroids, may be used to alleviate symptoms and potentially decrease antibiotic use, as mentioned in 1.
From the FDA Drug Label
Moxifloxacin hydrochloride tablets are a fluoroquinolone antibacterial indicated for treating infections in adults 18 years of age and older caused by designated susceptible bacteria, in the conditions listed below: ... Acute Bacterial Sinusitis (1.6) DOSAGE AND ADMINISTRATION ... Acute Bacterial Sinusitis (1. 6) 400 mg 10 Azithromycin is indicated for the treatment of acute bacterial sinusitis in pediatric patients (6 months of age or greater)
Treatment options for sinusitis in patients with a penicillin allergy:
- Moxifloxacin: 400 mg orally every 24 hours for 10 days 2
- Azithromycin: dosage regimen varies by age and weight, but is supported by adequate and well-controlled studies in adults and pediatric patients (6 months of age or greater) 3
From the Research
Treatment Options for Sinusitis in Patients with Penicillin Allergy
- For patients with a penicillin allergy, alternative antibiotics can be used to treat sinusitis, including cefuroxime, cefpodoxime, or cefdinir 4
- In cases of serious drug allergy, clarithromycin or azithromycin may be prescribed 4
- Erythromycin ethylsuccinate and sulfisoxazole or TMP-SMZ may be used in patients who are allergic to penicillin 5
- For patients with a penicillin allergy, second- or third-generation oral cephalosporins may be used as first-line therapy 6
- Clarithromycin has been suggested as an alternative to amoxicillin or cephalosporins in beta-lactam allergic patients 6
- Clinicians should be familiar with which antibiotics are safe to use for different types of penicillin-allergic reactions, and consider antimicrobial therapy with an antibiotic that does not cross-react with penicillins or beta-lactams 7
Antibiotic Selection
- Beta-lactam antibiotics may be used safely for patients with unknown/possible penicillin allergy and drug fever or rash 7
- Penicillins or beta-lactams should not be used for patients with hives or anaphylactic reactions 7
- The choice of antibiotic should be governed by the drug's known antimicrobial efficacy, resistance patterns, dosing schedules, the potential for compliance, and knowledge of the patient's drug allergies 6
Principles of Appropriate Antibiotic Use
- Antibiotic therapy should be reserved for patients with moderately severe symptoms who meet the criteria for the clinical diagnosis of acute bacterial rhinosinusitis and for those with severe rhinosinusitis symptoms-especially those with unilateral facial pain-regardless of duration of illness 8
- For initial treatment, the most narrow-spectrum agent active against the likely pathogens, Streptococcus pneumoniae and Haemophilus influenzae, should be used 8