From the Guidelines
For bacterial sinusitis, the first-line antibiotic treatment is amoxicillin-clavulanate, typically dosed at 45 mg/kg/day divided twice daily for children, for 5-7 days, as recommended by the American Academy of Pediatrics 1.
Key Considerations
- The diagnosis of acute bacterial sinusitis is made when a child presents with persistent illness, worsening course, or severe onset of symptoms 1.
- Amoxicillin with or without clavulanate is the first-line treatment of acute bacterial sinusitis, with the dosage depending on the severity of the illness and the presence of risk factors for resistant organisms 1.
- For patients with risk factors for resistant organisms, such as recent antibiotic use, healthcare exposure, or treatment failure, high-dose amoxicillin-clavulanate may be appropriate 1.
- A recent meta-analysis found no difference in clinical success among patients receiving short-course (3-7 days) versus long-course (6-10 days) therapy for acute bacterial sinusitis, suggesting that a shorter course of antibiotics may be sufficient 1.
Treatment Recommendations
- For uncomplicated acute bacterial sinusitis, amoxicillin-clavulanate is recommended at a standard dose of 45 mg/kg per day in 2 divided doses for children aged 2 years or older who do not attend child care and have not been treated with an antimicrobial agent within the last 4 weeks 1.
- For patients with moderate to severe illness, or those with risk factors for resistant organisms, high-dose amoxicillin-clavulanate (80-90 mg/kg per day of the amoxicillin component) may be appropriate 1.
- Alternative options, such as doxycycline or levofloxacin, may be considered for patients with penicillin allergy or other contraindications to amoxicillin-clavulanate 1.
Supporting Evidence
- The American Academy of Pediatrics recommends amoxicillin-clavulanate as the first-line treatment for acute bacterial sinusitis in children 1.
- A recent meta-analysis found that short-course antibiotic therapy is effective and may reduce adverse events compared to long-course therapy 1.
From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
2.1 Adult Patients Infection* Recommended Dose/Duration of Therapy ... Acute bacterial sinusitis 500 mg once daily for 3 days
2.2 Pediatric Patients Infection* Recommended Dose/Duration of Therapy ... Acute bacterial sinusitis 10 mg/kg once daily for 3 days
The recommended antibiotic dosing regimens for bacterial sinusitis are:
- For adults: 500 mg once daily for 3 days of azithromycin 2
- For pediatric patients: 10 mg/kg once daily for 3 days of azithromycin 2
1.14 Acute Bacterial Sinusitis: 5-day and 10 to 14 day Treatment Regimens Levofloxacin tablets are indicated in adult patients for the treatment of acute bacterial sinusitis (ABS) due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis
The recommended antibiotic dosing regimens for bacterial sinusitis are also:
- For adults: levofloxacin tablets for 5-day and 10 to 14 day treatment regimens 3
From the Research
Antibiotic Dosing Regimens for Bacterial Sinusitis
- The recommended antibiotic dosing regimens for bacterial sinusitis include high-dose amoxicillin or amoxicillin-clavulanate, with alternatives such as cefuroxime, cefpodoxime, or cefdinir 4.
- For penicillin-allergic patients or those unresponsive to amoxicillin, amoxicillin-clavulanate or alternatives like clarithromycin or azithromycin may be prescribed 4.
- 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.
Comparison of Antibiotic Regimens
- A study comparing 5-day and 10-day gatifloxacin regimens with a 10-day amoxicillin/clavulanate regimen found comparable clinical cure rates and tolerability among the three groups 5.
- Another study found that high-dose amoxicillin/clavulanate was associated with more rapid improvement in symptoms compared to standard-dose amoxicillin/clavulanate, but with a higher incidence of severe diarrhea 6.
- However, a subsequent study found no significant difference in efficacy between high-dose and standard-dose amoxicillin plus clavulanate, and the study was stopped for futility 7.
- A comparison of levofloxacin and amoxicillin-clavulanate found similar success rates, but with fewer drug-related adverse events in the levofloxacin group 8.
Key Findings
- High-dose amoxicillin or amoxicillin-clavulanate may be effective for treating bacterial sinusitis, but the optimal duration of therapy is unknown 4, 6.
- Alternative antibiotics like cefuroxime, cefpodoxime, or cefdinir may be used in patients who are allergic to penicillin or unresponsive to amoxicillin 4.
- The choice of antibiotic regimen should be based on the patient's specific needs and medical history, as well as the potential for adverse events 5, 7, 8.