From the Guidelines
If a patient fails levofloxacin treatment for a sinus infection in an outpatient setting, the next step should be to reassess the diagnosis and consider alternative antibiotic therapy, such as amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 10-14 days, as it provides coverage against beta-lactamase producing organisms that may be resistant to levofloxacin 1. This approach is based on the principle of using broader-spectrum antibiotics when initial treatment fails, as outlined in the practice parameter update for the diagnosis and management of sinusitis 1. Some key points to consider in this scenario include:
- Confirming that the patient completed the full course of levofloxacin and evaluating for complications or underlying conditions such as fungal sinusitis, immunodeficiency, or anatomical abnormalities that might require imaging studies or specialist consultation 1.
- Considering alternative antibiotic choices, such as doxycycline 100 mg twice daily for 10 days, especially if the patient has a penicillin allergy 1.
- Evaluating the need for referral to a specialist, such as an otolaryngologist, for possible culture-directed therapy or surgical intervention, particularly if the patient has recurrent or persistent infectious sinusitis despite adequate trials of medical management 1.
- Continuing symptomatic measures like saline irrigation, intranasal corticosteroids, and analgesics alongside antibiotic therapy to improve patient comfort and quality of life 1. It's also important to note that treatment failure may be due to resistant organisms, inadequate drug penetration into the sinuses, biofilm formation, or an incorrect initial diagnosis, and a thorough reassessment of the patient's condition is necessary to guide further management 1.
From the FDA Drug Label
If your infection does not get better while you take levofloxacin tablets, it may mean that the bacteria causing your infection may be resistant to levofloxacin tablets. If your infection does not get better, call your healthcare provider.
The patient should call their healthcare provider if the infection does not get better while taking levofloxacin tablets, as the bacteria causing the infection may be resistant to levofloxacin tablets 2.
From the Research
Next Steps After Levofloxacin Treatment Failure
If a patient fails levofloxacin treatment for sinus infection in an outpatient setting, the following options can be considered:
- Re-evaluation of the patient's condition to determine the cause of treatment failure, such as resistance to levofloxacin or presence of a complicated infection 3, 4
- Consideration of alternative antibiotic therapies, such as amoxicillin-clavulanate, which has been shown to be effective in treating acute sinusitis 3, 5
- Use of high-dose, short-course levofloxacin, which has been shown to be effective in treating acute bacterial sinusitis 6
- Evaluation of the patient's symptoms and medical history to determine the best course of treatment, including consideration of other factors such as age, comorbidities, and potential allergies or sensitivities to certain antibiotics 7
Alternative Antibiotic Therapies
Some alternative antibiotic therapies that can be considered include:
- Amoxicillin-clavulanate, which has been shown to be effective in treating acute sinusitis, but may have a higher risk of gastrointestinal symptoms and yeast infections 7, 5
- Other fluoroquinolones, such as moxifloxacin or gemifloxacin, which may have a broader spectrum of activity against certain pathogens 4
- Macrolides, such as azithromycin or clarithromycin, which may be effective against certain pathogens, but may have a higher risk of resistance 3
Considerations for Treatment Failure
When considering treatment failure, it is essential to evaluate the patient's condition and determine the cause of the failure, including: