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 folate inhibitors (trimethoprim-sulfamethoxazole), which is a cost-effective alternative to amoxicillin 1.
- The macrolide class of antibiotics, such as azithromycin or clarithromycin, may also be used for patients with penicillin allergy 1.
- Another option is a fluoroquinolone such as levofloxacin or moxifloxacin, which can be used in patients with sinusitis and a penicillin allergy 1.
Important Considerations
- 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 1.
- It's essential to consider the patient's age, general health, cardiopulmonary status, and comorbid conditions as part of the decision-making process 1.
- The duration of antibiotic therapy for sinusitis is not well defined, but a 10- to 14-day course of antibiotic might be adequate for most patients with acute disease 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
- Clindamycin may also be indicated as first-line treatment in patients who have culture-proven penicillin-resistant S. pneumoniae 6
Antibiotic Selection in Penicillin-Allergic Patients
- Clinicians should be familiar with which antibiotics are safe to use for different types of penicillin-allergic reactions 7
- 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
- For all patients, clinicians should consider antimicrobial therapy with an antibiotic that does not cross-react with penicillins or beta-lactams 7
Duration of Antibiotic Therapy
- 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
- Short-course antibiotic treatment has similar effectiveness to longer-course treatment for patients with acute uncomplicated bacterial sinusitis 8
- Shortened treatment, particularly for patients without severe disease and complicating factors, might lead to fewer adverse events, better patient compliance, lower rates of resistance development, and fewer costs 8