What is the treatment for sinusitis?

From the Guidelines

The treatment for sinusitis typically involves a combination of approaches to relieve symptoms and address the underlying cause, with the most recent and highest quality study suggesting the use of analgesics, saline irrigation, and topical nasal steroids for symptomatic relief. For mild cases, start with nasal saline irrigation (using a neti pot or squeeze bottle) 1-2 times daily and over-the-counter pain relievers like acetaminophen (Tylenol, 325-650mg every 4-6 hours) or ibuprofen (Advil, 200-400mg every 4-6 hours) 1. Nasal decongestant sprays such as oxymetazoline (Afrin) can provide short-term relief but shouldn't be used for more than 3 days to avoid rebound congestion. For moderate to severe cases, intranasal corticosteroids like fluticasone (Flonase, 1-2 sprays per nostril daily) or mometasone (Nasonex) can reduce inflammation. If symptoms persist beyond 7-10 days or include fever, facial pain, and thick, colored nasal discharge, antibiotics may be necessary. Amoxicillin (500mg three times daily for 5-10 days) is typically the first-line antibiotic, with amoxicillin-clavulanate (Augmentin) used for more resistant cases 1.

Some key points to consider in the treatment of sinusitis include:

• The use of systemic corticosteroid therapy for sinus disease has not been studied systematically in a well-controlled or blinded manner 1
• The addition of intranasal corticosteroids as an adjunct to antibiotic therapy might be modestly beneficial in the treatment of patients with recurrent acute or chronic sinusitis 1
• Evaluation should include coronal sinus CT with extra cuts through the ostiomeatal complex to clarify the extent of disease and specific location or locations 1
• Contemporary surgical therapy involves chiefly functional endoscopic sinus surgery 1

It's also important to note that staying hydrated, using a humidifier, and avoiding allergens can also support recovery. If sinusitis recurs frequently or becomes chronic, further evaluation by an ENT specialist may be needed to identify structural issues or underlying conditions.

From the FDA Drug Label

Table 1: Dosing in Patients Aged 12 weeks (3 months) and Older INFECTIONDOSING REGIMEN Every 12 hours 200 mg/5 mL or 400 mg/5 mL oral suspension a 125 mg/5 mL or 250 mg/5 mL oral suspension a Otitis media b, sinusitis, lower respiratory tract infections, and more severe infections 45 mg/kg/day every 12 hours 40 mg/kg/day every 8 hours

The treatment for sinusitis is amoxicillin-clavulanate, with a recommended dose of 45 mg/kg/day every 12 hours or 40 mg/kg/day every 8 hours for patients aged 12 weeks (3 months) and older, using the 200 mg/5 mL or 400 mg/5 mL oral suspension, or the 125 mg/5 mL or 250 mg/5 mL oral suspension 2.

From the Research

Treatment Options for Sinusitis

• The treatment for sinusitis depends on the severity and cause of the condition, with options including antibiotics, decongestants, and steam inhalation 3, 4, 5.
• For acute bacterial sinusitis, antibiotics such as amoxicillin or amoxicillin-clavulanate are commonly prescribed, with alternatives including cefuroxime, cefpodoxime, or cefdinir 3.
• In cases of serious drug allergy, clarithromycin or azithromycin may be prescribed 3.
• A study comparing azithromycin and amoxicillin/clavulanate found that a 3-day course of azithromycin was as effective and well tolerated as a 10-day course of amoxicillin/clavulanic acid in adults with acute sinusitis 6.

Duration of Therapy

• The optimal duration of therapy for sinusitis is unknown, but some recommend treatment until the patient becomes free of symptoms and then for an additional 7 days 3.
• A study found that antibiotics were more effective when given within the first 10 days of treatment, with no effect on later recurrence 7.

Chronic Sinusitis

• Chronic sinusitis is often treated with a combination of agents, including topical corticosteroids, mast cell stabilisers, or antihistamines, as well as steam inhalation and/or saline nasal douching 4, 5.
• In some cases, surgery may be necessary to improve ventilation and facilitate drainage of the sinuses 4.

Effectiveness of Antibiotics

• Antibiotics have been shown to be effective in the treatment of acute bacterial sinusitis, with a study finding that antibiotics reduced the risk of failure within 10 days by 3.3-fold, without impact on later recurrence 7.
• However, most cases of untreated acute sinusitis resolve spontaneously, and the effectiveness of antibiotics in real-life treatment settings is not well established 7.