What are the treatment options for sinusitis?

From the Guidelines

Treatment options for sinusitis should prioritize symptom management and antibiotic stewardship, with a focus on reducing morbidity, mortality, and improving quality of life. For mild cases, start with nasal saline irrigation (using a neti pot or squeeze bottle) 1-2 times daily, along with over-the-counter pain relievers like acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours, as recommended by 1. Decongestants such as pseudoephedrine (Sudafed) 30-60mg every 4-6 hours can help reduce congestion, but shouldn't be used for more than 3 days to avoid rebound congestion. For moderate to severe cases, intranasal corticosteroids like fluticasone (Flonase) or mometasone (Nasonex), 1-2 sprays per nostril daily, can reduce inflammation, as suggested by 1. If symptoms persist beyond 7-10 days or include fever, severe pain, or thick, colored nasal discharge, antibiotics may be necessary, with amoxicillin (500mg three times daily for 5-10 days) or amoxicillin-clavulanate (875/125mg twice daily for 5-10 days) being common prescriptions, as recommended by 1 and 1. For those with penicillin allergies, alternatives include doxycycline (100mg twice daily) or levofloxacin (500mg once daily), as suggested by 1. Staying hydrated, using a humidifier, and applying warm compresses to the face can provide additional relief by thinning mucus and reducing pressure. It's essential to note that the overuse of antibiotics can lead to resistance, and their use should be guided by the severity of symptoms and the likelihood of bacterial infection, as emphasized by 1 and 1. In cases where symptoms are severe or persistent, consultation with a specialist may be necessary to determine the best course of treatment and to rule out any underlying conditions that may be contributing to the sinusitis, as recommended by 1.

Some key points to consider when treating sinusitis include:

• The use of antibiotics should be reserved for cases where bacterial infection is suspected, and their use should be guided by the severity of symptoms and the likelihood of bacterial infection, as emphasized by 1 and 1.
• Intranasal corticosteroids can be effective in reducing inflammation and improving symptoms, as suggested by 1.
• Decongestants and pain relievers can provide symptomatic relief, but their use should be limited to avoid rebound congestion and other adverse effects, as recommended by 1.
• Staying hydrated, using a humidifier, and applying warm compresses to the face can provide additional relief by thinning mucus and reducing pressure.
• Consultation with a specialist may be necessary in cases where symptoms are severe or persistent, or where underlying conditions may be contributing to the sinusitis, as recommended by 1.

Overall, the treatment of sinusitis should prioritize symptom management, antibiotic stewardship, and the reduction of morbidity, mortality, and improvement of quality of life, as emphasized by 1 and 1.

From the FDA Drug Label

1. 6 Acute Bacterial Sinusitis Moxifloxacin hydrochloride tablets are indicated in adult patients (18 years of age and older) for the treatment of acute bacterial sinusitis (ABS) caused by susceptible isolates of Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis [see CLINICAL STUDIES (14. 1)].

The treatment option for sinusitis is moxifloxacin hydrochloride tablets for adult patients (18 years of age and older) with acute bacterial sinusitis (ABS) caused by susceptible isolates of Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis 2.

• Key points:
  • Moxifloxacin hydrochloride tablets are indicated for the treatment of ABS.
  • The tablets are effective against susceptible isolates of Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.
  • Moxifloxacin hydrochloride tablets should be reserved for treatment of ABS in patients who have no alternative treatment options due to the risk of serious adverse reactions.

From the Research

Treatment Options for Sinusitis

• The treatment guidelines for acute bacterial sinusitis recommend 10 to 14 days of therapy with amoxicillin/clavulanate, high-dose amoxicillin, cefpodoxime, cefuroxime, or a newer fluoroquinolone 3.
• Therapy may be initiated with high-dose amoxicillin or amoxicillin-clavulanate, and alternatives include cefuroxime, cefpodoxime, or cefdinir 4.
• For penicillin-allergic patients or those who are unresponsive to amoxicillin, amoxicillin-clavulanate is appropriate, and in cases of serious drug allergy, clarithromycin or azithromycin may be prescribed 4.
• A short course (5 days) of gatifloxacin therapy was associated with comparable clinical cure rates and tolerability to those of standard 10-day therapy with gatifloxacin or amoxicillin/clavulanate 3.
• High-dose amoxicillin plus clavulanate may be superior to standard-dose amoxicillin plus clavulanate in adults with acute sinusitis, but further study is needed to confirm these findings 5, 6.
• Levofloxacin is as effective and better tolerated than amoxicillin-clavulanate for treating acute sinusitis in adult outpatients 7.

Antibiotic Treatment

• Amoxicillin/clavulanate is a commonly recommended treatment for acute bacterial sinusitis 3, 4, 5, 6.
• Gatifloxacin is a newer fluoroquinolone that has been shown to be effective in treating acute bacterial sinusitis 3.
• Levofloxacin is another fluoroquinolone that has been shown to be effective and well-tolerated in treating acute sinusitis in adult outpatients 7.
• Cefuroxime, cefpodoxime, and cefdinir are alternative antibiotics that may be used to treat acute bacterial sinusitis 4.

Treatment Duration

• 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 4.
• A short course (5 days) of gatifloxacin therapy was associated with comparable clinical cure rates and tolerability to those of standard 10-day therapy with gatifloxacin or amoxicillin/clavulanate 3.
• High-dose amoxicillin plus clavulanate for 7 days was compared to standard-dose amoxicillin plus clavulanate for 7 days in a randomized clinical trial 6.