What is the treatment for paranasal sinusitis?

From the Guidelines

Treatment for paranasal sinusitis should begin with supportive care and medical therapy, prioritizing watchful waiting and symptomatic relief over immediate antibiotic use, as recommended by the American Academy of Otolaryngology–Head and Neck Surgery 1.

Key Principles of Treatment

• For acute sinusitis, start with nasal saline irrigation and intranasal corticosteroids like fluticasone (2 sprays per nostril daily) or mometasone.
• Over-the-counter pain relievers such as acetaminophen or ibuprofen can help manage discomfort.
• Antibiotics are only recommended if symptoms persist beyond 10 days, worsen after initial improvement, or are severe from the onset.

Antibiotic Use

• In cases where antibiotics are necessary, amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days) is the first-line antibiotic, as suggested by the American College of Physicians and the Centers for Disease Control and Prevention 1.

Chronic Sinusitis Management

• Longer courses of intranasal corticosteroids are recommended, sometimes with a short course of oral steroids like prednisone (20-40 mg daily for 5-7 days).
• Patients should avoid environmental irritants, maintain adequate hydration, and use a humidifier to keep mucous membranes moist.

Surgical Options

• If medical therapy fails, especially in chronic cases with anatomical obstructions or polyps, surgical options like functional endoscopic sinus surgery may be necessary, as indicated by guidelines for the diagnosis and management of sinusitis 1.

Adjunctive Therapies

• Analgesics, decongestants, and mucolytics may provide symptomatic relief, but their use should be individualized based on patient symptoms and response to treatment, as discussed in the clinical practice guideline update for adult sinusitis 1.

From the FDA Drug Label

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)]. 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).

Treatment for Paranasal Sinusitis:

• Levofloxacin is approved for the treatment of acute bacterial sinusitis (ABS) using either 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days.
• The clinical success rate in patients with ABS was 91.4% in the levofloxacin 750 mg group and 88.6% in the levofloxacin 500 mg group at the test-of-cure visit.
• The treatment is effective against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. 2

From the Research

Treatment Options for Paranasal Sinusitis

• The treatment for paranasal sinusitis depends on the severity and cause of the condition, with options including antibiotics, nasal irrigation, and symptomatic relief 3, 4, 5.
• For acute bacterial rhinosinusitis (ABRS), the recommended first-line therapy is amoxicillin, with the option to prescribe symptomatic relief for managing viral rhinosinusitis or ABRS 3.
• Observation without antibiotics is an option for selected adults with uncomplicated ABRS who have mild illness and assurance of follow-up 3.
• Antimicrobial nasal washes can be used for chronic rhinosinusitis (CRS), with recommendations for agent selection, concentration, length of treatment, and dosing schedule 4.
• Fluticasone nasal spray can be used as an adjunct to amoxicillin for acute sinusitis in children, with studies showing reduced symptom severity and improved recovery rates 6.

Management of Acute and Chronic Sinusitis

• The management of ABRS should include an assessment of pain, with analgesic treatment based on the severity of pain 3.
• Clinicians should distinguish CRS and recurrent acute rhinosinusitis from isolated episodes of ABRS and other causes of sinonasal symptoms 3.
• Computed tomography of the paranasal sinuses can be used in diagnosing or evaluating a patient with CRS or recurrent acute rhinosinusitis 3.
• Nasal irrigation can be used alone or in combination with antibiotics for the treatment of acute sinusitis in children, with studies showing significant clinical improvement 7.

Best Practices for Clinical Diagnoses and Management

• Learning to recognize and differentiate between acute and chronic sinusitis helps facilitate appropriate and timely diagnoses and provides better counseling and care for patients 5.
• Clinicians should educate and counsel patients with CRS or recurrent acute rhinosinusitis regarding control measures 3.
• The use of evidence-based recommendations and guidelines can assist clinicians in making informed decisions for the diagnosis and management of paranasal sinusitis 3, 4, 5.