From the Guidelines
I recommend treating this patient with amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days, as suggested by the most recent guidelines 1. The patient's symptoms, particularly the foul-smelling nasal drainage, strongly suggest a recurrence of the bacterial sinusitis. Staphylococcus aureus is a common pathogen in chronic sinusitis, and the previous culture showing heavy growth supports this diagnosis. However, the guidelines recommend amoxicillin with or without clavulanate as the first-line therapy for acute bacterial rhinosinusitis (ABRS) 1. I would also recommend saline nasal irrigation twice daily to help clear mucus and bacteria from the sinuses. If symptoms don't improve within 3-5 days of starting antibiotics, the patient should be reevaluated, as resistant bacteria or other complications may be present. A follow-up appointment in two weeks would be appropriate to ensure resolution of symptoms and consider whether further investigation with imaging or ENT referral is needed if this represents a recurrent problem. It's also important to note that the patient's history of previous treatment with Bactrim DS and its effectiveness should be taken into consideration, but the guidelines suggest amoxicillin with or without clavulanate as the first-line therapy 1. Additionally, the patient's condition should be reassessed to confirm ABRS, exclude other causes of illness, and detect complications, as suggested by the guidelines 1. The guidelines also recommend distinguishing CRS and recurrent ARS from isolated episodes of ABRS and other causes of sinonasal symptoms, and assessing the patient for multiple chronic conditions that would modify management 1. However, the most recent and highest quality study suggests that amoxicillin with or without clavulanate should be the first-line therapy for ABRS 1.
From the FDA Drug Label
ZYVOX formulations are indicated in the treatment of the following infections caused by susceptible strains of the designated microorganisms... Nosocomial pneumonia caused by Staphylococcus aureus (methicillin-susceptible and -resistant strains) Complicated skin and skin structure infections, including diabetic foot infections, without concomitant osteomyelitis, caused by Staphylococcus aureus (methicillin-susceptible and -resistant strains)
The patient has a persistent sinus infection with a previous nasal culture showing heavy growth of Staphylococcus aureus. The drug label for linezolid indicates it is used to treat infections caused by Staphylococcus aureus, including nosocomial pneumonia and complicated skin and skin structure infections. However, it does not specifically mention sinus infections.
- The patient's previous treatment with Bactrim DS was effective, but the current situation is unclear.
- There is no direct information in the label to support the use of linezolid for sinus infections.
- Key considerations for treatment include the type of infection, susceptibility of the microorganism, and potential for resistance. 2
From the Research
Patient's Condition
The patient is a 55-year-old male with a persistent sinus infection, reporting foul-smelling nasal drainage. A previous nasal culture showed heavy growth of Staphylococcus aureus, which was effectively treated with Bactrim DS (trimethoprim/sulfamethoxazole) 3.
Treatment Options
- Trimethoprim/sulfamethoxazole (TMP/SMX) has been shown to be effective in treating Staphylococcus aureus infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA) 3, 4.
- A study found that TMP-SMX therapy reduced failure and recurrence in MRSA skin abscesses after surgical drainage 5.
- However, the effectiveness of TMP/SMX may depend on the specific strain of S. aureus and the severity of the infection 6, 4.
Pathogenesis and Regulatory Mechanisms
- Staphylococcus aureus is a major human pathogen that can cause a wide range of clinical infections, including bloodstream infections and endocarditis 6, 7.
- The pathogenesis of S. aureus infections involves the bacterium's ability to hijack the host defense and coagulation systems, as well as interact with the blood vessel endothelium 7.
- Understanding the regulatory mechanisms employed by S. aureus during invasive infections may provide insights into the development of novel therapies for treating bloodstream infections 7.