What is the diagnosis and treatment for sinusitis?

From the Guidelines

For acute sinusitis, the most effective treatment approach is to start with nasal saline irrigation twice daily and an over-the-counter decongestant like pseudoephedrine (Sudafed) 30-60mg every 4-6 hours for up to 3 days to reduce congestion, and consider antibiotics only if symptoms persist beyond 7-10 days or include fever, green/yellow discharge, and facial pain, as recommended by 1. The treatment of sinusitis should prioritize reducing symptoms and preventing complications, while also considering the potential risks and benefits of antibiotic therapy. Some key points to consider in the treatment of sinusitis include:

• Using a humidifier at night and applying warm compresses to the face can provide additional relief, as suggested by 1.
• Acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil) 400-600mg every 6-8 hours can be used for pain and inflammation, as is common practice.
• If symptoms persist or worsen, consultation with a specialist should be sought, particularly if there is a need to clarify the allergic or immunologic basis for sinusitis, or if sinusitis is refractory to usual antibiotic treatment, as recommended by 1.
• For chronic sinusitis, consideration should be given to systemic corticosteroids, and in cases of medically resistant sinusitis, nasal-sinus surgery may be necessary, as suggested by 1.
• It is also important to note that the use of antibiotics should be guided by the severity and duration of symptoms, and that amoxicillin 500mg three times daily for 5-7 days is typically the first-line antibiotic, or amoxicillin-clavulanate 875/125mg twice daily for 5-7 days if symptoms are severe, as recommended by 1. In terms of specific treatment approaches, the following can be considered:
• For acute bacterial sinusitis in children, antibiotics should be prescribed in cases of severe, worsening, or persistent illness, with amoxicillin alone or in combination with clavulanate as the first-line choice, as recommended by 1.
• In cases of recurrent sinusitis, consultation with an ENT specialist is recommended to rule out underlying structural issues or chronic conditions, as suggested by 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

Definition and Symptoms of Sinusitis

• Sinusitis is defined pathologically as transient inflammation of the mucosal lining of the paranasal sinuses lasting less than 4 weeks 3
• Clinically, it is characterized by nasal congestion, rhinorrhoea, facial pain, hyposmia, sneezing, and, if more severe, additional malaise and fever 3

Treatment Options for Sinusitis

• Antibiotics such as amoxicillin, amoxicillin-clavulanic acid, doxycycline, cephalosporins, and macrolides are commonly used to treat acute bacterial sinusitis 4, 5, 3, 6, 7
• A study comparing high-dose versus standard-dose amoxicillin/clavulanate for clinically-diagnosed acute bacterial sinusitis found that adults with clinically diagnosed acute bacterial sinusitis were more likely to improve rapidly when treated with immediate-release high-dose amoxicillin/clavulanate than with standard-dose 4
• Another study comparing azithromycin versus amoxicillin/clavulanate in the treatment of acute sinusitis found that a 3-day course of azithromycin was as effective and well tolerated as a 10-day course of amoxicillin/clavulanic acid 5
• A study comparing azithromycin extended release vs amoxicillin/clavulanate found that more patients randomized to azithromycin extended release experienced symptom resolution at day 5 than those randomized to amoxicillin/clavulanate 6
• A study comparing once daily clarithromycin extended-release vs twice-daily amoxicillin/clavulanate in patients with acute bacterial sinusitis found that clarithromycin ER was comparable, and for selected measures superior, to amoxicillin/clavulanate based on clinical, bacteriological, and radiological responses as well as quality of life measures 7

Efficacy and Safety of Treatment Options

• The efficacy and safety of different antibiotics for the treatment of acute bacterial sinusitis have been evaluated in several studies 4, 5, 3, 6, 7
• A systematic review of 19 systematic reviews, RCTs, or observational studies found that antibiotics, antihistamines, decongestants, saline nasal washes, steam inhalation, and topical corticosteroids have been used to treat acute sinusitis, but the quality of evidence for these interventions varies 3
• The most common side effects of antibiotics used to treat acute bacterial sinusitis include gastrointestinal disturbances, such as diarrhea and nausea 4, 5, 6, 7