What are the clinical presentation and treatment options for acute sinusitis?

From the Guidelines

Acute sinusitis typically presents with nasal congestion, purulent nasal discharge, facial pain or pressure, decreased sense of smell, and sometimes fever and headache, and most cases are viral and self-limiting, requiring only symptomatic treatment. The clinical presentation of acute sinusitis can vary, but common symptoms include nasal congestion, purulent rhinorrhea, postnasal drainage, facial or dental pain, headache, and cough, frequently with a more severe nocturnal component 1. Symptoms lasting less than 4 weeks indicate acute sinusitis, with bacterial infection suspected when symptoms persist beyond 10 days, worsen after initial improvement, or are severe with high fever and purulent discharge for 3-4 days.

Treatment Options

• Symptomatic treatment including saline nasal irrigation, intranasal corticosteroids (such as fluticasone 1-2 sprays per nostril daily), and analgesics like acetaminophen or ibuprofen is recommended for most cases of acute sinusitis 1.
• Antibiotics should be reserved for suspected bacterial sinusitis, with amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days) as first-line therapy 1.
• For penicillin-allergic patients, doxycycline (100 mg twice daily) or a respiratory fluoroquinolone like levofloxacin (750 mg daily) can be used 1.
• Decongestants may provide short-term relief but should be limited to 3-5 days to avoid rebound congestion 1.
• Patients should stay hydrated and consider using a humidifier to help alleviate symptoms.

Complications and Referral

• If symptoms worsen despite treatment, persist beyond 4 weeks, or include severe headache, visual changes, or mental status changes, immediate medical attention is necessary as these may indicate complications requiring specialist intervention 1.
• Patients with suspected complications, such as orbital or intracranial involvement, should be referred to a specialist for further evaluation and management 1.

From the FDA Drug Label

Table 1: Dosing in Patients Aged 12 weeks (3 months) and Older INFECTIONDOSING REGIMEN Every 12 hours 200 mg/5 mL or 400 mg/5 mL oral suspension a 125 mg/5 mL or 250 mg/5 mL oral suspension a Otitis media b, sinusitis, lower respiratory tract infections, and more severe infections 45 mg/kg/day every 12 hours 40 mg/kg/day every 8 hours

The clinical presentation of acute sinusitis is not directly described in the provided drug label. However, the treatment options for sinusitis are mentioned, with dosing regimens provided in Table 1, including:

• 45 mg/kg/day every 12 hours for more severe infections
• 40 mg/kg/day every 8 hours for more severe infections
• 25 mg/kg/day every 12 hours for less severe infections
• 20 mg/kg/day every 8 hours for less severe infections 2

From the Research

Clinical Presentation of Acute Sinusitis

• Acute sinusitis is characterized by nasal congestion, rhinorrhoea, facial pain, hyposmia, sneezing, and, if more severe, additional malaise and fever 3
• Cardinal features of acute bacterial rhinosinusitis include unilateral facial pain or pressure, fever greater than 102°F (39°C), and purulent nasal discharge with obstruction of the nasal passages 4
• Patients with acute sinusitis often have purulent nasal discharge, facial pain, and congestion 5

Treatment Options for Acute Sinusitis

• Antibiotics should be considered for patients with 3 or more days of severe symptoms, significant worsening after 3 to 5 days of symptoms, or 7 or more days of symptoms 4
• Amoxicillin is as effective as amoxicillin-clavulanate as a first-line treatment for acute bacterial rhinosinusitis for those without a beta-lactam allergy 4
• Supportive care for rhinosinusitis, including use of saline irrigation, nasal steroids or antihistamines, and decongestants, may help reduce the severity of symptoms 4
• Intranasal corticosteroids offer a small therapeutic benefit in acute sinusitis, which may be greater with high doses and with courses of 21 days' duration 6
• Decongestants, saline nasal washes, steam inhalation, and topical corticosteroids (intranasal) are also considered as treatment options for acute sinusitis 3