What is the diagnosis and treatment for sinusitis?

From the Guidelines

For acute sinusitis, antibiotics should only be prescribed if symptoms persist beyond 10 days or worsen after initial improvement, with amoxicillin or amoxicillin-clavulanate being first-line options 1. When managing sinusitis, it's essential to consider the underlying cause, whether it's viral, bacterial, or allergic. Symptom management is crucial, and this can include saline nasal irrigation, over-the-counter pain relievers like acetaminophen or ibuprofen, and decongestants such as pseudoephedrine. Some key points to consider in the management of sinusitis include:

• The use of antibiotics, which should be reserved for cases where symptoms persist or worsen, as indicated by the 2005 study 1.
• The role of intranasal corticosteroids, such as fluticasone, in the treatment of chronic sinusitis, as mentioned in the same study 1.
• The importance of addressing drainage and inflammation to prevent recurrence, which is a key aspect of sinusitis treatment. In terms of specific treatment options, the following can be considered:
• Amoxicillin (500mg three times daily for 5-10 days) or amoxicillin-clavulanate (875/125mg twice daily for 5-10 days) for acute sinusitis, as recommended by the 2005 study 1.
• Intranasal corticosteroids like fluticasone (1-2 sprays per nostril daily) for chronic sinusitis, as suggested by the same study 1. It's also important to note that consultation with a specialist should be sought in certain cases, such as when sinusitis is refractory to usual antibiotic treatment, recurrent, or significantly affects performance and quality of life, as indicated by the 2005 study 1.

From the FDA Drug Label

Acute bacterial sinusitis 500 mg QD × 3 days The recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with acute bacterial sinusitis is 10 mg/kg once daily for 3 days.

Azithromycin Dosage for Sinusitis:

• For adults, the recommended dose is 500 mg once daily for 3 days.
• For pediatric patients, the recommended dose is 10 mg/kg once daily for 3 days. 2

From the Research

Treatment Options for Sinusitis

• Amoxicillin/clavulanate is a commonly recommended treatment for acute bacterial sinusitis, but its effectiveness can be limited 3, 4
• High-dose amoxicillin/clavulanate may be more effective than standard-dose in some cases, but results are inconsistent 3, 4
• Other antibiotics, such as gatifloxacin, azithromycin, and doxycycline, have also been studied as potential treatments for sinusitis 5, 6
• Non-antibiotic treatments, such as antihistamines, decongestants, saline nasal washes, steam inhalation, and topical corticosteroids, may also be effective in managing symptoms 7

Efficacy of Different Treatments

• A 5-day course of gatifloxacin was found to be as effective as a 10-day course of amoxicillin/clavulanate in one study 5
• A 3-day course of azithromycin was found to be as effective as a 10-day course of amoxicillin/clavulanate in another study 6
• High-dose amoxicillin/clavulanate was found to be more effective than standard-dose in one study, but not in another 3, 4

Safety and Tolerability

• Amoxicillin/clavulanate is generally well-tolerated, but can cause gastrointestinal side effects such as diarrhea 3, 4
• Other antibiotics, such as gatifloxacin and azithromycin, may also cause side effects such as diarrhea and nausea 5, 6
• Non-antibiotic treatments, such as antihistamines and decongestants, may also cause side effects such as drowsiness and dry mouth 7