What antibiotic is effective for treating acute sinusitis?

From the Guidelines

For a sinus infection, watchful waiting without antibiotic therapy is the preferred initial management, as most cases are self-limited and resolve without antibiotics. This approach is supported by the American Academy of Otolaryngology–Head and Neck Surgery 1. When antibiotics are necessary, amoxicillin–clavulanate is the preferred agent, with doxycycline or a respiratory fluoroquinolone as alternative options 1. However, it's essential to note that antibiotics are only beneficial for a small proportion of patients, with a number needed to treat of 18 for 1 patient to be cured rapidly, while the number needed to harm from adverse effects is 8 1.

Some key points to consider when managing sinus infections include:

• Most patients with acute rhinosinusitis have more adverse effects than benefits from antibiotics 1
• Supportive care, such as analgesics, antipyretics, and saline nasal irrigation, can provide symptomatic relief 1
• Antibiotic treatment should be reserved for patients with persistent symptoms or severe infections 1
• Patients who are seriously ill, deteriorate clinically despite antibiotic therapy, or have recurrent episodes should be referred to a specialist 1

In terms of specific antibiotic regimens, amoxicillin–clavulanate is the preferred agent, with a dosage of 875mg/125mg twice daily. However, the choice of antibiotic and dosage should be individualized based on patient factors, such as allergy history and severity of infection. It's also important to complete the full course of antibiotics, even if symptoms improve before finishing, to ensure effective treatment and minimize the risk of resistance.

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 [see Clinical Studies (14.4)].

Levofloxacin is indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis 2.

• The treatment regimens are 5 days and 10 to 14 days.
• Levofloxacin can be used to treat mild, moderate, and severe infections caused by susceptible bacteria.
• It is essential to perform culture and susceptibility tests before treatment to determine the susceptibility of the bacteria to levofloxacin.

From the Research

Antibiotic Treatment for Sinus Infection

• The choice of antibiotic for sinus infection depends on various factors, including the severity of symptoms, patient's medical history, and presence of allergies 3.
• Amoxicillin or amoxicillin-clavulanate are commonly prescribed antibiotics for acute bacterial sinusitis, with high-dose amoxicillin or amoxicillin-clavulanate being recommended for more severe cases 3, 4.
• Alternative antibiotics, such as cefuroxime, cefpodoxime, or cefdinir, may be prescribed for patients who are allergic to penicillin or unresponsive to amoxicillin 3.
• For patients with serious drug allergies, clarithromycin or azithromycin may be prescribed 3.
• The optimal duration of antibiotic therapy is unknown, but treatment is typically continued until the patient becomes free of symptoms and then for an additional 7 days 3.

Comparison of Antibiotics

• Studies have compared the effectiveness of different antibiotics in treating acute bacterial sinusitis, including amoxicillin, amoxicillin-clavulanate, and cefdinir 4, 5.
• High-dose amoxicillin/clavulanate has been shown to be more effective than standard-dose amoxicillin/clavulanate in some studies, but with a higher risk of side effects such as diarrhea 4.
• Cefdinir has been found to be as effective as amoxicillin-clavulanate in treating acute community-acquired bacterial sinusitis, with similar microbiologic eradication rates and fewer adverse events requiring treatment discontinuation 5.

Diagnosis and Treatment Guidelines

• Acute rhinosinusitis is a clinical diagnosis, and distinguishing between bacterial and viral sinusitis can be challenging 6.
• Antibiotics should be considered for patients with severe symptoms, significant worsening after 3-5 days of symptoms, or 7 or more days of symptoms 6.
• Supportive care, including saline irrigation, nasal steroids or antihistamines, and decongestants, may help reduce the severity of symptoms 6.
• Complications of rhinosinusitis are rare but may include orbital cellulitis, meningitis, and abscess, and computed tomography and referral to an otolaryngologist should be considered for patients with recurrent rhinosinusitis or concern about complications 6.