What is the treatment for sinusitis?

From the Guidelines

Sinusitis treatment should prioritize symptomatic relief with analgesics, saline irrigation, and topical intranasal corticosteroids, while reserving antibiotics for cases with suspected bacterial infection, as recommended by the most recent guidelines 1.

Treatment Approach

For mild cases of sinusitis, over-the-counter pain relievers like acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours can help manage pain and inflammation.

• Nasal saline irrigation using a neti pot or squeeze bottle with sterile saline solution twice daily is also beneficial in flushing mucus and irritants.
• Nasal decongestant sprays like oxymetazoline (Afrin) can provide short-term relief but should not be used for more than 3 days to avoid rebound congestion.

Antibiotic Use

For moderate to severe cases, a healthcare provider may prescribe antibiotics such as amoxicillin 500mg three times daily for 5-10 days if bacterial infection is suspected, particularly if symptoms persist beyond 10 days or worsen after initial improvement, as suggested by earlier guidelines 1.

• However, the use of antibiotics should be judicious and based on clear indications of bacterial infection, given the concerns about overdiagnosis and unnecessary antibiotic treatment 1.

Adjunctive Therapies

Intranasal corticosteroids like fluticasone (Flonase) or mometasone (Nasonex), 1-2 sprays per nostril daily, can reduce inflammation and are recommended for chronic rhinosinusitis (CRS) 1.

• Staying hydrated, applying warm compresses to the face, and sleeping with your head elevated can provide additional relief by promoting drainage and reducing congestion.

Specialist Consultation

Consultation with a specialist should be sought for cases that are refractory to usual treatment, recurrent, or significantly affect performance and quality of life, especially when concomitant conditions are present that complicate assessment or treatment 1.

From the FDA Drug Label

For more severe infections and infections of the respiratory tract, the dose should be one 875 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours or one 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours. Table 1: Dosing in Patients Aged 12 weeks (3 months) and Older INFECTIONDOSING REGIMEN Every 12 hours 200 mg/5 mL or 400 mg/5 mL oral suspension a Otitis media b, sinusitis, lower respiratory tract infections, and more severe infections 45 mg/kg/day every 12 hours

The recommended dose of amoxicillin-clavulanate for sinusitis treatment in patients aged 12 weeks and older is 45 mg/kg/day every 12 hours or 40 mg/kg/day every 8 hours for more severe infections, and 25 mg/kg/day every 12 hours or 20 mg/kg/day every 8 hours for less severe infections 2.

From the Research

Treatment Options for Sinusitis

• Antibiotics are often prescribed for acute bacterial sinusitis, with amoxicillin/clavulanate being a common choice 3, 4, 5, 6
• High-dose amoxicillin may lead to more rapid improvement in symptoms, but also increases the risk of severe diarrhea 3
• Alternative antibiotics, such as cefuroxime, cefpodoxime, or cefdinir, may be used in patients with penicillin allergy or those who are unresponsive to amoxicillin 4, 5
• Supportive care, including saline irrigation, nasal steroids or antihistamines, and decongestants, may help reduce the severity of symptoms 5, 6

Duration of Treatment

• The optimal duration of antibiotic therapy is unknown, but treatment is often continued for 10 to 14 days 4, 5
• Some studies suggest that treatment should be continued until the patient becomes free of symptoms and then for an additional 7 days 4

Special Considerations

• Patients with beta-lactam allergy may require alternative antibiotics, such as doxycycline or a respiratory fluoroquinolone 4, 5, 6
• Patients with chronic rhinosinusitis may require longer courses of antibiotic therapy and may benefit from nasal irrigation and corticosteroids 7
• Complications of rhinosinusitis, such as orbital cellulitis or meningitis, require prompt medical attention and may require referral to an otolaryngologist 6