From the Guidelines
Most patients with acute sinusitis should be managed with supportive care, and antibiotics should be reserved for patients with persistent symptoms or severe disease.
Management of Acute Sinusitis
- Supportive care: includes analgesics for pain, antipyretics for fever, and additional therapies such as systemic or topical decongestants, saline nasal irrigation, mucolytics, intranasal corticosteroids, and antihistamines tailored to the patient's symptoms 1.
- Antibiotic therapy: should be reserved for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving 1.
- First-line antibiotic therapy: includes amoxicillin-clavulanate, second-generation oral cephalosporins (cefuroxime-axetil), and some third-generation oral cephalosporins (cefpodoxime-proxetil, cefotiam-hexetil) 1.
- Duration of treatment: is usually 7-10 days, but may be shorter for newer antibiotics, and longer for chronic infectious sinusitis 1.
- Adjunctive therapy: includes intranasal corticosteroids, antihistamines, decongestants, saline irrigation, mucolytics, and expectorants, which may provide symptomatic benefit in selected cases 1.
- Consultation with a specialist: should be sought when sinusitis is refractory to usual antibiotic treatment, recurrent, or associated with unusual opportunistic infections, or when concomitant conditions are present that complicate assessment or treatment 1.
From the Research
Management of Acute Sinusitis
The management of acute sinusitis involves a combination of medical and surgical interventions. The primary goal of treatment is to resolve the infection, leading to patency of the ostiomeatal complex 2.
Medical Management
- Antibiotics and decongestants are the cornerstones of therapy for acute sinusitis 2.
- First-line antibiotic therapy includes adequate dosages of trimethoprim-sulfamethoxazole, loracarbef, and amoxicillin-clavulanate 2.
- Decongestants and mucoevacuants may reduce tissue edema, facilitate drainage, and maintain ostial patency 2.
- Topical corticosteroids are useful additional therapy in allergic rhinosinusitis and as an aid in the long-term management of chronic sinusitis 2.
- Antimicrobials such as amoxycillin-clavulanate, the newer quinolones, and the second generation cephalosporins are effective in the management of acute sinusitis 3.
Diagnosis and Treatment Algorithms
- Diagnosis of acute sinusitis is based on the history and physical findings 2.
- Treatment algorithms are presented for adult and pediatric sinusitis, taking into account the pathophysiology and diagnosis of acute sinusitis, infectious agents, treatment methods, antibiotic resistance patterns, and costs associated with the management of sinusitis 4.
- Imaging studies are not cost-effective in the initial assessment and treatment of patients in the primary care setting, but may be indicated to resolve the diagnosis in patients with an equivocal history or to follow patients admitted to hospital with severe sinus disease 5.
Surgical Intervention
- Surgical intervention is occasionally helpful in the management of acute sinusitis, particularly in cases with nasal polyps and radiographic evidence of sinus obstruction 6.
- In the chronic phase of sinusitis or after the patient has been followed with persistent abnormalities for over three months, irreversibly diseased mucosa is generally present and surgical intervention is commonly indicated 6.