What is a suitable second course of antibiotics for a patient with a penicillin (pcn) allergy, who has already been treated with clarithromycin (Biaxin) for sinusitis?

From the Guidelines

For a patient with a penicillin allergy who has already been treated with clarithromycin for sinusitis, a suitable second course of antibiotics could be cefpodoxime or cefdinir, as they are effective against common respiratory pathogens, including S pneumoniae 1. When considering alternative antibiotics for a patient with a penicillin allergy, it's crucial to select medications that are effective against the common bacterial pathogens in sinusitis, such as Streptococcus pneumoniae and Haemophilus influenzae.

• Cefpodoxime and cefdinir are third-generation cephalosporins that can be given orally once or twice daily and have suitable activity against these pathogens 1.
• Other options like ciprofloxacin, levofloxacin, gemifloxacin, moxifloxacin, and grepafloxacin are also effective but may have specific indications and potential side effects to consider 1.
• The choice of antibiotic should be based on the severity of the sinusitis, the patient's medical history, and potential drug interactions.
• It's also important to note that the duration of antibiotic therapy for sinusitis is not well defined, but a 10- to 14-day course may be adequate for most patients, and treatment should continue until the patient is free of symptoms plus 7 days 1.
• Monitoring for side effects and adjusting the treatment plan as necessary is crucial for effective management of sinusitis in patients with penicillin allergies.

From the Research

Suitable Second Course of Antibiotics for Sinusitis

For a patient with a penicillin (pcn) allergy who has already been treated with clarithromycin for sinusitis, the following options can be considered for a second course of antibiotics:

• Azithromycin, as it is a suitable alternative for patients with penicillin allergy and has been shown to be effective in treating sinusitis 2, 3
• Cefuroxime, cefpodoxime, or cefdinir, as they are alternatives for penicillin-allergic patients, although the cross-reactivity between penicillins and second- or third-generation cephalosporins should be considered 4, 5
• Amoxicillin-clavulanate, if the patient is not allergic to amoxicillin, as it is an appropriate alternative for penicillin-allergic patients 4

Key Considerations

When selecting a second course of antibiotics, it is essential to consider the patient's allergy history and the potential for cross-reactivity between different antibiotics 5. Additionally, the effectiveness and safety of short-course antibiotic treatment for acute bacterial sinusitis should be taken into account, as it may be a suitable option for some patients 6.

Alternative Options

If the above options are not suitable, other alternatives may include:

• Desensitization therapy, if the patient has a suspected immunoglobulin E-mediated antibiotic allergy and the efficacy of alternate antibiotics is in doubt 5
• Other macrolides, such as erythromycin, although they may have a higher rate of gastrointestinal side effects 2