From the FDA Drug Label
- 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
The recommended treatment for bacterial pansinusitis is levofloxacin tablets. The treatment regimens are either 5 days or 10 to 14 days, and the specific pathogens that can be treated with levofloxacin include:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis 1
From the Research
The recommended treatment for bacterial pansinusitis is a 5-day course of antibiotics, such as amoxicillin-clavulanate (875/125 mg twice daily), due to its effectiveness against common sinus pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, as supported by the evidence from 2.
Key Considerations
- The choice of antibiotic should provide adequate coverage against the most important pathogens, and guidelines from different specialist societies can be helpful in making this decision 2.
- For patients with penicillin allergies, alternatives include doxycycline (100 mg twice daily), levofloxacin (500 mg daily), or moxifloxacin (400 mg daily) 3, 4.
- Severe cases or those with complications may require broader-spectrum antibiotics like high-dose amoxicillin-clavulanate (2000/125 mg twice daily) or combination therapy for 10-14 days 4.
Adjunctive Treatments
- Intranasal corticosteroids, such as fluticasone (1-2 sprays per nostril daily), can help reduce inflammation.
- Saline nasal irrigation can improve mucus clearance.
- Analgesics can be used for pain management.
- Decongestants may provide temporary symptom relief but should be limited to 3-5 days to avoid rebound congestion.
Monitoring and Follow-up
- If symptoms worsen or fail to improve after 72 hours of treatment, patients should seek reevaluation as this may indicate antibiotic resistance, complications, or an incorrect diagnosis.
- Bacterial pansinusitis requires aggressive treatment because the infection involves all the paranasal sinuses and can potentially spread to nearby structures including the orbit and brain if left untreated.