What are the symptoms and treatment options for a sinus infection?

From the Guidelines

Sinus infections typically present with facial pain or pressure, nasal congestion, thick yellow or green nasal discharge, reduced sense of smell, headache, fever, and sometimes a cough or sore throat, and treatment options depend on whether the infection is viral or bacterial, with a focus on symptom relief for viral infections and antibiotics for bacterial infections suspected when symptoms last over 10 days or worsen after initial improvement. The symptoms of sinus infections can vary, but common signs include:

• Nasal congestion and obstruction
• Purulent nasal discharge
• Maxillary tooth pain
• Facial pain or pressure
• Fever
• Fatigue
• Cough
• Hyposmia or anosmia
• Ear pressure or fullness
• Headache
• Halitosis As noted in the study by 1, determining the likelihood of a bacterial infection is crucial for appropriate management. Treatment options for sinus infections include:
• Over-the-counter pain relievers like acetaminophen (325-650mg every 4-6 hours) or ibuprofen (200-400mg every 4-6 hours)
• Saline nasal sprays
• Nasal decongestants like pseudoephedrine (30-60mg every 4-6 hours for no more than 3 days to avoid rebound congestion)
• Antibiotics such as amoxicillin (500mg three times daily for 5-10 days) or amoxicillin-clavulanate if symptoms are severe, as recommended by 1
• Home remedies like steam inhalation, warm compresses on the face, and staying hydrated It's essential to seek medical attention promptly if symptoms persist beyond two weeks, worsen significantly, or include high fever, severe headache, or visual changes, as advised by 1. Antibiotics should only be used for bacterial infections, as they are ineffective against viruses and contribute to antibiotic resistance when used unnecessarily, a concern highlighted by 1. In cases of medically resistant sinusitis, consultation with a specialist may be necessary, and appropriate nasal-sinus surgery might be considered, as suggested by 1.

From the FDA Drug Label

1. 4 Acute Bacterial Sinusitis: 5 Day and 10 to 14 Day Treatment Regimens Levofloxacin is approved for the treatment of acute bacterial sinusitis (ABS) using either 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days To evaluate the safety and efficacy of a high dose short course of levofloxacin, 780 outpatient adults with clinically and radiologically determined acute bacterial sinusitis were evaluated in a double-blind, randomized, prospective, multicenter study comparing levofloxacin 750 mg by mouth once daily for five days to levofloxacin 500 mg by mouth once daily for 10 days Clinical success rates (defined as complete or partial resolution of the pre-treatment signs and symptoms of ABS to such an extent that no further antibiotic treatment was deemed necessary) in the microbiologically evaluable population were 91.4% (139/152) in the levofloxacin 750 mg group and 88.6% (132/149) in the levofloxacin 500 mg group at the test-of-cure (TOC) visit (95% CI [-4. 2,10] for levofloxacin 750 mg minus levofloxacin 500 mg).

The symptoms of sinus infection are not explicitly listed in the provided drug labels, but the treatment options for acute bacterial sinusitis (ABS) are described.

• Treatment options for ABS include:
  • Levofloxacin 750 mg by mouth once daily for 5 days
  • Levofloxacin 500 mg by mouth once daily for 10 to 14 days
• Clinical success rates for these treatment options are:
  • 91.4% for the 750 mg group
  • 88.6% for the 500 mg group 2

From the Research

Symptoms of Sinus Infection

• The cardinal features of acute bacterial rhinosinusitis include unilateral facial pain or pressure, fever greater than 102°F (39°C), and purulent nasal discharge with obstruction of the nasal passages 3
• Other symptoms may include facial pain, nasal congestion, and purulent rhinorrhea with unilateral predominance 4
• Patients with acute sinusitis often have purulent nasal discharge, facial pain, and congestion, whereas those with chronic sinusitis have more subtle signs 5

Treatment Options for Sinus Infection

• Antibiotics should be considered for patients with 3 or more days of severe symptoms, significant worsening after 3 to 5 days of symptoms, or 7 or more days of symptoms 3
• Amoxicillin is as effective as amoxicillin-clavulanate as a first-line treatment for acute bacterial rhinosinusitis for those without a beta-lactam allergy 3
• For patients with a beta-lactam allergy, appropriate antibiotics include doxycycline or a respiratory fluoroquinolone; clindamycin plus a third-generation cephalosporin is an option for children with non-type I hypersensitivity to beta-lactam antibiotics 3
• Intranasal corticosteroids may offer a small therapeutic benefit in acute sinusitis, which may be greater with high doses and with courses of 21 days' duration 6
• Systemic corticosteroids as an adjunctive therapy to oral antibiotics are effective for short-term relief of symptoms in acute sinusitis 7
• Topical nasal steroid may be beneficial in patients with less severe symptoms at baseline 4
• Supportive care for rhinosinusitis, including use of saline irrigation, nasal steroids or antihistamines, and decongestants, may help reduce the severity of symptoms 3