From the Guidelines
For acute bacterial sinusitis, the first-line antibiotic treatment is amoxicillin with or without clavulanate for 5 to 10 days, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1.
Key Considerations
- The choice of antibiotic should be based on the severity of symptoms and the presence of risk factors for resistant organisms.
- Amoxicillin-clavulanate is the preferred agent, but alternatives such as doxycycline or a respiratory fluoroquinolone may be used in patients with penicillin allergy or other contraindications.
- Treatment should be initiated when symptoms persist beyond 10 days, are severe, or worsen after initial improvement.
Supportive Measures
- Saline irrigation, intranasal corticosteroids, and analgesics may be used to alleviate symptoms and support antibiotic therapy.
- Patients who are seriously ill, deteriorate clinically despite antibiotic therapy, or have recurrent episodes should be referred to a specialist.
High-Value Care Advice
- 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 and purulent nasal discharge or facial pain, or onset of worsening symptoms following a typical viral illness that was initially improving 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 [see Clinical Studies (14.4)].
The antibiotic treatment options for acute bacterial sinusitis include levofloxacin, which is indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis. The recommended treatment regimens are 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days 2.
- Key pathogens:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
- Treatment regimens:
- 750 mg by mouth x 5 days
- 500 mg by mouth once daily x 10 to 14 days
From the Research
Antibiotic Treatment Options for Acute Bacterial Sinusitis
- The primary antibiotics used to treat acute bacterial sinusitis include amoxicillin, amoxicillin-clavulanate, cefuroxime, cefpodoxime, and cefdinir 3, 4.
- For patients with a penicillin allergy, alternatives such as clarithromycin or azithromycin may be prescribed 3.
- In cases of serious drug allergy, fluoroquinolones or doxycycline can be considered 4, 5.
- The optimal duration of antibiotic therapy is unknown, but treatment is typically continued until the patient becomes free of symptoms and then for an additional 7-10 days 3, 4.
Considerations for Antibiotic Resistance
- The increasing prevalence of penicillin-resistant Streptococcus pneumoniae and beta-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis requires careful selection of antibiotics 3, 5.
- High-dose amoxicillin-clavulanate may be effective in treating acute bacterial sinusitis caused by antimicrobial-resistant S. pneumoniae 6, 5.
- Pharmacokinetically enhanced formulations of amoxicillin-clavulanate can provide adequate coverage of beta-lactamase-producing pathogens 5.
Supportive Care and Diagnostic Considerations
- Supportive care, including saline irrigation, nasal steroids or antihistamines, and decongestants, may help reduce the severity of symptoms 4, 7.
- Diagnostic testing for acute rhinosinusitis is typically clinical, with point-of-care testing for elevated C-reactive protein potentially helpful but not widely available 7.
- Computed tomography and referral to an otolaryngologist should be considered for patients with recurrent rhinosinusitis or concern about complications 7.