From the Guidelines
The most effective treatment for sinusitis involves a combination of saline nasal irrigation, topical intranasal corticosteroids, and antibiotics, with the specific approach depending on whether the condition is acute or chronic, as recommended by the most recent and highest quality study 1.
Treatment Approach
For acute sinusitis, the initial treatment should focus on managing symptoms, with options including:
- Saline nasal irrigation 2-3 times daily
- Over-the-counter pain relievers like acetaminophen (325-650mg every 4-6 hours) or ibuprofen (400-600mg every 6-8 hours)
- Decongestants such as pseudoephedrine (30mg every 4-6 hours) for temporary relief, but not exceeding 3-5 days to avoid rebound congestion If symptoms persist beyond 7-10 days or are severe, antibiotics may be necessary, with amoxicillin (500mg three times daily for 5-10 days) typically being the first choice, and amoxicillin-clavulanate (875/125mg twice daily for 5-10 days) for more resistant cases, as suggested by 1 and 1.
Chronic Sinusitis
For chronic sinusitis, the treatment approach may involve:
- Longer courses of antibiotics
- Intranasal corticosteroids like fluticasone (1-2 sprays per nostril daily)
- Oral steroids in some cases
- Maintaining hydration, using a humidifier, and avoiding allergens to support recovery
- Consideration of surgical intervention, such as functional endoscopic sinus surgery, for cases with significant nasal septal deviation, obstructing nasal polyps, or recurrent symptoms despite aggressive medical management, as outlined in 1.
Key Considerations
- The role of bacterial infection and the importance of antibiotic therapy are controversial in chronic sinusitis, but a minimum of 3 weeks of treatment with an antibiotic effective against H influenzae, mouth anaerobes, and S pneumoniae may be efficacious, as noted in 1.
- The treatment of chronic sinusitis should also consider the presence of underlying risk factors, such as allergic factors, and the evaluation of unusual pathogens and immunodeficiency, with consultation with an allergist-immunologist or otolaryngologist as needed, as recommended by 1 and 1.
From the FDA Drug Label
1.2 Acute Maxillary Sinusitis Clarithromycin extended-release tablets (in adults) are indicated for the treatment of mild to moderate infections caused by susceptible isolates due to Haemophilus influenzae, Moraxella catarrhalis,or Streptococcus pneumoniae
2.2 Adult Dosage The recommended dosages of clarithromycin extended-release tablets for the treatment of mild to moderate infections in adults are listed in Table 1. Table 1 Adult Dosage Guidelines Clarithromycin Extended-release Tablets Infection Dosage (every 24 hours) Duration (days) ... Acute maxillary sinusitis 1 gram 14
Treatment for Sinusitis: Clarithromycin extended-release tablets are indicated for the treatment of mild to moderate acute maxillary sinusitis in adults, caused by susceptible isolates due to Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae. The recommended dosage is 1 gram every 24 hours for 14 days 2.