From the Guidelines
The best antibiotic for treating sinusitis in Florida is typically amoxicillin-clavulanate (Augmentin), usually prescribed at 875/125 mg twice daily for 5-7 days for uncomplicated cases. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of reserving antibiotic treatment for patients with persistent symptoms or those who are seriously ill 1. For patients with penicillin allergies, alternatives include doxycycline (100 mg twice daily) or a respiratory fluoroquinolone, as suggested by the American College of Physicians and the Centers for Disease Control and Prevention 1.
Before starting antibiotics, it's essential to note that most cases of sinusitis are viral and will resolve without antibiotics within 7-10 days. The American Academy of Otolaryngology–Head and Neck Surgery recommends watchful waiting (without antibiotic therapy) as initial management for all patients with uncomplicated acute bacterial rhinosinusitis (ABRS), regardless of severity 1. Antibiotics should be reserved for bacterial sinusitis, characterized by symptoms lasting more than 10 days, severe symptoms with high fever (>102°F), or worsening symptoms after initial improvement.
Some key points to consider when treating sinusitis in Florida include:
- The use of adjunctive therapy, such as intranasal saline irrigation or intranasal corticosteroids, which has been shown to alleviate symptoms and potentially decrease antibiotic use 1.
- The importance of supportive care, including analgesics for pain and antipyretics for fever, as well as additional therapies like systemic or topical decongestants, mucolytics, and antihistamines tailored to the patient's symptoms 1.
- The need to refer patients who are seriously ill, who deteriorate clinically despite antibiotic therapy, or who have recurrent episodes to a specialist, such as an otolaryngologist, infectious disease specialist, or allergist 1.
From the FDA Drug Label
1.4 Acute Bacterial Sinusitis: 5 Day and 10 to 14 Day Treatment Regimens Levofloxacin tablets are indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis 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
The best antibiotic for treating sinusitis in Florida is levofloxacin, with a clinical success rate of 91.4% for the 750 mg dose and 88.6% for the 500 mg dose 2.
- Levofloxacin 750 mg is effective against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
- Levofloxacin 500 mg is also effective against these pathogens, but with a slightly lower clinical success rate. Note that the choice of antibiotic should be based on the specific needs of the patient and the susceptibility of the causative organism.
From the Research
Antibiotic Treatment for Sinusitis in Florida
The best antibiotic for treating sinusitis in Florida depends on the type of sinusitis (acute or chronic) and the causative pathogens.
- For acute sinusitis, the most effective antimicrobials are:
- For chronic sinusitis, the most effective antimicrobials are:
Pathogens Involved in Sinusitis
The bacterial pathogens involved in acute sinusitis are:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis While in chronic sinusitis, anaerobic bacteria and Staphylococcus aureus are predominant 3.
Resistance Patterns
Many of these organisms have developed resistance to penicillins, either through the production of beta-lactamase or through changes in the penicillin-binding protein 3, 4, 7.
Treatment Duration
The optimal duration of therapy is unknown, but some recommend treatment until the patient becomes free of symptoms and then for an additional 7 days 4.