From the Guidelines
The recommended treatment for sinusitis depends on whether it's viral or bacterial, with viral sinusitis typically managed with symptom relief measures and bacterial sinusitis requiring antibiotics. For viral sinusitis, which is most common, treatment focuses on symptom relief with:
- Saline nasal irrigation
- Over-the-counter pain relievers like acetaminophen or ibuprofen (400-600mg every 6-8 hours)
- Decongestants such as pseudoephedrine (30-60mg every 4-6 hours, not exceeding 240mg daily) Bacterial sinusitis may require antibiotics, typically amoxicillin (500mg three times daily) or amoxicillin-clavulanate (875/125mg twice daily) for 5-10 days, as recommended by 1. Intranasal corticosteroids like fluticasone (1-2 sprays per nostril daily) can reduce inflammation in both types, as suggested by 1. Home remedies include applying warm compresses to the face, staying hydrated, and using a humidifier. Most cases resolve within 7-10 days with proper treatment. If symptoms persist beyond 10 days, worsen after initial improvement, or include high fever and severe facial pain, medical attention should be sought as this may indicate complications requiring more aggressive treatment, as noted in 1. It's also important to consider the potential for antibiotic resistance, as discussed in 1 and 1, and to choose antibiotics accordingly. For chronic sinusitis, a minimum of 3 weeks of treatment with an antibiotic effective against H influenzae, mouth anaerobes, and S pneumoniae may be necessary, along with oral treatment with an older-generation A/D twice per day and 5 days of treatment with a nasal decongestant twice per day, as outlined in 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 To evaluate the safety and efficacy of a high dose short course of levofloxacin, 780 outpatient adults with clinically and radiologically determined acute bacterial sinusitis were evaluated in a double-blind, randomized, prospective, multicenter study comparing levofloxacin 750 mg by mouth once daily for five days to levofloxacin 500 mg by mouth once daily for 10 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
- Recommended treatment for sinusitis:
- Levofloxacin 750 mg by mouth x 5 days
- Levofloxacin 500 mg by mouth once daily x 10 to 14 days Clinical success rates were 91.4% and 88.6% respectively 2
- Alternative treatment option:
- Azithromycin 500 mg QD × 3 days 3
From the Research
Treatment Options for Sinusitis
- The recommended treatment for acute bacterial sinusitis includes 10 to 14 days of therapy with amoxicillin/clavulanate, high-dose amoxicillin, cefpodoxime, cefuroxime, or a newer fluoroquinolone 4.
- Alternative treatments include azithromycin or clarithromycin for patients with serious drug allergies or those who are unresponsive to amoxicillin 5.
- A short course (5 days) of gatifloxacin therapy has been shown to be associated with comparable clinical cure rates and tolerability to those of standard 10-day therapy with gatifloxacin or amoxicillin/clavulanate 4.
Antibiotic Dosage and Duration
- High-dose amoxicillin/clavulanate may be more effective than standard-dose amoxicillin/clavulanate in adults with acute bacterial sinusitis, with a higher percentage of patients reporting major improvement after 3 days of treatment 6.
- However, another study found that high-dose amoxicillin plus clavulanate did not provide a significant benefit over standard-dose amoxicillin plus clavulanate in adults with acute sinusitis 7.
- 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 5.
Comparison of Antibiotics
- A 3-day course of azithromycin has been shown to be as effective and well-tolerated as a 10-day course of amoxicillin/clavulanate in adults with acute sinusitis, with a significantly faster resolution of signs and symptoms 8.
- Azithromycin and amoxicillin/clavulanate have been shown to have similar bacteriologic eradication rates, with 23 of 23 and 21 of 24 patients treated with azithromycin and amoxicillin/clavulanate, respectively, achieving eradication 8.