From the Guidelines
Treatment for sinusitis should begin with managing symptoms while the infection resolves, and for bacterial sinusitis, antibiotics like amoxicillin or amoxicillin-clavulanate are commonly prescribed, as recommended by the American Academy of Pediatrics 1.
Treatment Options
- For mild cases, over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can reduce pain and inflammation.
- Nasal saline irrigation using a neti pot or squeeze bottle with sterile saline solution helps flush out mucus and irritants.
- Decongestants such as pseudoephedrine (Sudafed) can provide temporary relief but shouldn't be used for more than 3 days to avoid rebound congestion.
- For bacterial sinusitis, antibiotics like amoxicillin (500mg three times daily for 5-10 days) or amoxicillin-clavulanate (875/125mg twice daily for 5-10 days) are commonly prescribed, with the choice of antibiotic depending on the severity of the illness and the patient's risk factors for resistance 1.
- Nasal corticosteroid sprays like fluticasone (Flonase) or mometasone (Nasonex), typically 1-2 sprays per nostril daily, reduce inflammation and can be used for longer periods.
Additional Recommendations
- Staying hydrated, applying warm compresses to the face, and sleeping with your head elevated can also help.
- If symptoms persist beyond 10 days or worsen after initial improvement, consult a healthcare provider as you may need stronger treatment or have a different condition.
- The Infectious Diseases Society of America recommends amoxicillin-clavulanate as initial empirical antimicrobial therapy for acute bacterial sinusitis in children, due to the increasing prevalence of H influenzae as a cause of sinusitis and the increasing prevalence of β-lactamase production among these strains 1.
- The American Academy of Otolaryngology-Head and Neck Surgery recommends saline nasal irrigation, topical intranasal corticosteroids, or both for symptom relief of chronic rhinosinusitis, based on a preponderance of benefit over harm 1.
From the FDA Drug Label
Acute bacterial sinusitis 500 mg QD × 3 days The recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with acute bacterial sinusitis is 10 mg/kg once daily for 3 days.
Treatment options for sinusitis include:
- Azithromycin 500 mg once daily for 3 days for adults
- Azithromycin 10 mg/kg once daily for 3 days for pediatric patients 2
From the Research
Treatment Options for Sinusitis
- Antibiotics are commonly prescribed for the treatment of acute sinusitis, but most cases are caused by viral infections and will resolve without antibiotic therapy 3, 4, 5
- Intranasal corticosteroids, such as mometasone furoate nasal spray, can be used as an adjunct to antibiotics or as monotherapy to relieve inflammation and symptoms 3, 6
- Amoxicillin is a commonly recommended antibiotic for the treatment of acute bacterial rhinosinusitis, but alternatives such as amoxicillin-clavulanate, cefuroxime, cefpodoxime, or cefdinir may be used in cases of penicillin allergy or resistance 4, 5
- Supportive care, including saline irrigation, nasal steroids or antihistamines, and decongestants, may help reduce the severity of symptoms 5
- Azithromycin has been shown to be as effective as amoxicillin/clavulanate in the treatment of acute sinusitis, with a simpler dosage regimen and faster clinical effect 7
Antibiotic Treatment
- High-dose amoxicillin or amoxicillin-clavulanate may be initiated for the treatment of acute bacterial sinusitis 4
- The optimal duration of antibiotic therapy is unknown, but treatment may be continued until the patient becomes free of symptoms and then for an additional 7 days 4
- In cases of serious drug allergy, clarithromycin or azithromycin may be prescribed as an alternative to amoxicillin 4