What are the best antibiotics (abx) for treating sinus infections?

From the Guidelines

The best antibiotic for sinus infections is typically amoxicillin-clavulanate (Augmentin), usually prescribed as 875/125 mg twice daily for 5-7 days for uncomplicated cases. For patients with penicillin allergies, alternatives include doxycycline (100 mg twice daily for 5-7 days) or a respiratory fluoroquinolone like levofloxacin (500 mg once daily for 5-7 days) 1. However, antibiotics should only be used for bacterial sinusitis, which is typically diagnosed when symptoms last longer than 10 days, are severe with high fever and purulent discharge, or worsen after initial improvement 1. Most sinus infections are viral and will resolve without antibiotics in 7-10 days. While taking antibiotics, patients should stay hydrated, use saline nasal irrigation, and consider over-the-counter pain relievers and decongestants for symptom relief. Antibiotics work by targeting the bacterial cell walls or protein synthesis mechanisms of common sinus pathogens like Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. If symptoms don't improve after 3-5 days of antibiotic treatment, patients should follow up with their healthcare provider.

Some key points to consider when treating sinus infections include:

• Using antibiotics only when necessary to avoid contributing to antibiotic resistance 1
• Choosing the right antibiotic based on the patient's symptoms and medical history 1
• Encouraging patients to stay hydrated and use saline nasal irrigation to help relieve symptoms 1
• Monitoring patients for signs of improvement or worsening symptoms, and adjusting treatment as needed 1

It's also important to note that some patients may require alternative treatments, such as:

• Patients with penicillin allergies may require alternative antibiotics like doxycycline or levofloxacin 1
• Patients with severe symptoms or complications may require more aggressive treatment, such as intravenous antibiotics or hospitalization 1
• Patients with recurrent sinus infections may require further evaluation and treatment to address underlying causes 1

From the FDA Drug Label

1. 4 Acute Bacterial Sinusitis: 5 Day and 10 to 14 Day Treatment Regimens Levofloxacin is approved for the treatment of acute bacterial sinusitis (ABS) using either 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days To evaluate the safety and efficacy of a high dose short course of levofloxacin, 780 outpatient adults with clinically and radiologically determined acute bacterial sinusitis were evaluated in a double-blind, randomized, prospective, multicenter study comparing levofloxacin 750 mg by mouth once daily for five days to levofloxacin 500 mg by mouth once daily for 10 days Clinical success rates (defined as complete or partial resolution of the pre-treatment signs and symptoms of ABS to such an extent that no further antibiotic treatment was deemed necessary) in the microbiologically evaluable population were 91.4% (139/152) in the levofloxacin 750 mg group and 88.6% (132/149) in the levofloxacin 500 mg group at the test-of-cure (TOC) visit (95% CI [-4. 2,10] for levofloxacin 750 mg minus levofloxacin 500 mg).

Levofloxacin is a possible treatment option for acute bacterial sinusitis, with 91.4% clinical success rate for the 5-day regimen and 88.6% for the 10-14 day regimen 2.

• Dosage options: 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days.
• Efficacy: Clinical success rates were 91.4% for the 5-day regimen and 88.6% for the 10-14 day regimen.

Another option is Clarithromycin, which is indicated for the treatment of mild to moderate acute maxillary sinusitis caused by susceptible isolates due to Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae 3.

• Dosage: 1 gram every 24 hours for 14 days.
• Efficacy: Not specified in the provided text for acute bacterial sinusitis.

From the Research

Treatment Options for Sinus Infections

The following antibiotics are commonly used to treat sinus infections:

• Amoxicillin or amoxicillin-clavulanate as first-line treatment 4, 5, 6
• Cefuroxime, cefpodoxime, or cefdinir as alternative options 4
• Clarithromycin or azithromycin for patients with serious drug allergies 4, 7
• Doxycycline or a respiratory fluoroquinolone for patients with beta-lactam allergies 6
• Clindamycin plus a third-generation cephalosporin for children with non-type I hypersensitivity to beta-lactam antibiotics 6

Efficacy of Different Antibiotics

Studies have compared the efficacy of different antibiotics in treating sinus infections:

• High-dose amoxicillin/clavulanate was more effective than standard-dose amoxicillin/clavulanate in one study 5
• Levofloxacin was as effective as amoxicillin-clavulanate in another study 8
• Clarithromycin extended-release was comparable to amoxicillin/clavulanate in a randomized, investigator-blinded study 7

Duration of Treatment

The optimal duration of treatment for sinus infections is unknown, but some studies recommend treatment until the patient becomes free of symptoms and then for an additional 7 days 4