What is the recommended treatment for acute sinusitis?

From the Guidelines

The recommended treatment for acute sinusitis typically begins with supportive care measures, including adequate hydration, saline nasal irrigation, and over-the-counter pain relievers, with antibiotics reserved for severe or persistent cases. The treatment approach should prioritize reducing symptoms and preventing complications, while minimizing unnecessary antibiotic use.

Supportive Care

• Adequate hydration to thin out mucus
• Saline nasal irrigation to clear nasal passages
• Over-the-counter pain relievers such as acetaminophen or ibuprofen for pain and fever management

Symptom Relief

• Intranasal corticosteroids (like fluticasone 1-2 sprays per nostril daily or mometasone 2 sprays per nostril daily) to reduce inflammation 1
• Decongestants such as pseudoephedrine (120mg twice daily for adults) for temporary relief, but not to be used for more than 3-5 days to avoid rebound congestion

Antibiotic Use

Antibiotics are generally not recommended for uncomplicated acute sinusitis within the first 7-10 days, as most cases are viral and resolve spontaneously 1. However, if symptoms persist beyond 10 days, worsen after initial improvement, or are severe (high fever, facial pain, purulent discharge), antibiotics may be appropriate. First-line antibiotic therapy is typically amoxicillin-clavulanate (875/125mg twice daily for 5-7 days) or, for penicillin-allergic patients, doxycycline (100mg twice daily for 5-7 days) 1.

Follow-Up

Patients should follow up if symptoms worsen or fail to improve after complete treatment. Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening) 1.

From the FDA Drug Label

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

The recommended treatment for acute sinusitis is levofloxacin 750 mg by mouth once daily for 5 days or 500 mg by mouth once daily for 10 to 14 days.

• The clinical success rates for levofloxacin 750 mg and 500 mg are 91.4% and 88.6%, respectively.
• Levofloxacin is effective against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 2.

From the Research

Treatment Options for Acute Sinusitis

• The recommended treatment for acute sinusitis includes antibiotics, with the choice of antibiotic depending on the severity of the infection and the patient's medical history 3.
• For patients with mild to moderate acute sinusitis, amoxicillin or amoxicillin-clavulanate are commonly prescribed as first-line treatments 3, 4.
• In cases of penicillin allergy or resistance, alternative antibiotics such as cefuroxime, cefpodoxime, or cefdinir may be used 3.
• For patients with serious drug allergies, clarithromycin or azithromycin may be prescribed as alternative treatments 3.

Duration of Antibiotic Therapy

• The optimal duration of antibiotic therapy for acute sinusitis is unknown, but most guidelines recommend a treatment course of 10-14 days 3, 5.
• However, some studies suggest that shorter courses of antibiotic therapy (5-7 days) may be effective in treating acute sinusitis, especially in uncomplicated cases 5, 6.
• A study comparing the effectiveness of levofloxacin and amoxicillin-clavulanate for the treatment of acute sinusitis found that a 10-14 day treatment course was effective in achieving high success rates (88.4% and 87.3%, respectively) 6.

Comparative Effectiveness of Antibiotics

• A retrospective cohort study comparing the effectiveness of amoxicillin versus amoxicillin-clavulanate among adults with acute sinusitis found that amoxicillin demonstrated similar efficacy to amoxicillin-clavulanate with fewer gastrointestinal-related adverse events 4.
• The study suggested that amoxicillin is a viable option for adults with acute sinusitis who meet criteria for antibiotic therapy, especially in patients with comorbidities 4.