What are the symptoms and treatment options for sinusitis (sinus infection)?

From the Guidelines

Most sinus infections are viral and will resolve within 7-10 days without antibiotics. For symptom relief, patients can take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for pain and fever, and use a saline nasal spray or rinse to clear mucus 1. Decongestants like pseudoephedrine (Sudafed) can help reduce congestion, but shouldn't be used for more than 3 days to avoid rebound congestion.

Key Considerations

• Stay hydrated, rest, apply warm compresses to your face, and use a humidifier to keep nasal passages moist.
• If symptoms persist beyond 10 days, worsen after initial improvement, or include high fever (over 102°F), severe facial pain, or changes in vision, see a doctor as you may need antibiotics for a bacterial infection 1.
• Antibiotics commonly prescribed include amoxicillin (500mg three times daily for 5-10 days) or amoxicillin-clavulanate if symptoms are severe.

Diagnosis and Treatment

• Determining the likelihood of a bacterial infection is crucial, as acute rhinosinusitis is usually caused by a viral pathogen 1.
• The gold standard for diagnosis of bacterial sinusitis is sinus puncture with aspiration of purulent secretions, although it is rarely performed.
• Common bacteria isolated from sinus puncture are listed in the Table, and radiographic imaging has no role in ascertaining a bacterial cause 1.

Adjuvant Therapy

• There are no recommendations regarding adjuvant therapy for acute bacterial sinusitis, although intranasal corticosteroids, saline nasal irrigation or lavage, topical or oral decongestants, mucolytics, and topical or oral antihistamines may be options 1.
• One Cochrane review found no appropriately designed studies to establish the effectiveness of decongestants, antihistamines, and nasal irrigation for acute sinusitis in children.

From the FDA Drug Label

Levofloxacin tablets are indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis [see Clinical Studies (14.4)]. 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

Levofloxacin is effective for the treatment of acute bacterial sinusitis. The clinical success rates for levofloxacin 750 mg and 500 mg were 91.4% and 88.6%, respectively. 2

From the Research

Definition and Diagnosis of Sinus Infection

• Sinus infection, also known as acute 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.
• The diagnosis of acute bacterial sinusitis (ABS) can be confirmed with images and appropriate antibiotics 4.
• The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends distinguishing presumed acute bacterial rhinosinusitis (ABRS) from acute rhinosinusitis caused by viral upper respiratory infections and noninfectious conditions 5.

Causes and Risk Factors of Sinus Infection

• The predominant bacterial species implicated in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in children 4.
• In adults, the causes of sinusitis can be viral or bacterial, and may be related to other conditions such as allergic rhinitis, cystic fibrosis, or immunocompromised state 5.
• The increasing prevalence of penicillin-resistant S. pneumoniae, and beta-lactamase-producing H. influenzae and M. catarrhalis has been noted in recent years 4.

Treatment and Management of Sinus Infection

• The treatment of ABS may be initiated with high-dose amoxicillin or amoxicillin-clavulanate 4.
• Alternatives include cefuroxime, cefpodoxime, or cefdinir, and in cases of serious drug allergy, clarithromycin or azithromycin may be prescribed 4.
• The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends assessing pain and providing analgesic treatment based on the severity of pain, and prescribing amoxicillin as first-line therapy for most adults with ABRS 5.
• Pseudoephedrine may be used to treat symptoms of sinusitis, but its use is also associated with risks and potential for misuse 6.

Prevention and Control Measures

• The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends educating patients with chronic rhinosinusitis (CRS) or recurrent acute rhinosinusitis regarding control measures 5.
• Clinicians may prescribe symptomatic relief in managing viral rhinosinusitis or ABRS, and observation without use of antibiotics is an option for selected adults with uncomplicated ABRS 5.