From the Guidelines
For acute sinusitis with onset 1 week ago, I recommend starting with symptomatic treatment including analgesics such as acetaminophen (500-1000 mg every 6 hours as needed) or ibuprofen (400-600 mg every 6-8 hours with food) for pain and fever. Intranasal saline irrigation 2-3 times daily and topical decongestants like oxymetazoline (2 sprays per nostril twice daily for no more than 3 days to avoid rebound congestion) can help relieve nasal congestion. Most cases of acute sinusitis are viral and resolve within 7-10 days without antibiotics, as noted in the clinical practice guideline update by 1. However, if symptoms are severe, persist beyond 10 days, or worsen after initial improvement, antibiotics may be warranted, as suggested by 1 and 1. First-line antibiotic therapy is amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days. For penicillin-allergic patients, doxycycline 100 mg twice daily or levofloxacin 500 mg once daily for 5-7 days are alternatives, as recommended by 1. Advise the patient to maintain adequate hydration, rest, and elevate the head while sleeping. Antibiotics are prescribed selectively because most cases are viral, and unnecessary antibiotic use contributes to resistance while exposing patients to potential side effects without benefit, as emphasized by 1. Some key points to consider in management include:
- Symptomatic relief with analgesics and decongestants
- Use of intranasal saline irrigation for nasal congestion
- Selective use of antibiotics based on symptom duration and severity
- Patient education on the natural history of the disease and the potential benefits and risks of antibiotic therapy, as discussed in 1 and 1.
From the FDA Drug Label
Levofloxacin tablets are indicated in adult patients for the treatment of acute bacterial sinusitis (ABS) due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis [see Clinical Studies (14. 4)]. Because fluoroquinolones, including levofloxacin tablets, have been associated with serious adverse reactions [see Warnings and Precautions (5.1to 5.15)] and for some patients ABS is self-limiting, reserve levofloxacin tablets for treatment of ABS in patients who have no alternative treatment options.
Treatment for Acute Sinusitis:
- Levofloxacin can be given to a patient with acute sinusitis onset 1 week ago, for the treatment of acute bacterial sinusitis (ABS) due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.
- However, it should be reserved for patients who have no alternative treatment options due to the potential for serious adverse reactions.
- The patient should be monitored for any adverse reactions and the treatment should be adjusted accordingly 2.
Alternative Option:
- Azithromycin is also an option for the treatment of acute bacterial sinusitis in pediatric patients (6 months of age or greater) and adults, as supported by adequate and well-controlled trials 3.
From the Research
Treatment Options for Acute Sinusitis
The treatment for acute sinusitis can vary depending on the severity and duration of symptoms. According to 4, therapy may be initiated with high-dose amoxicillin or amoxicillin-clavulanate. In penicillin-allergic patients or those who are unresponsive to amoxicillin, amoxicillin-clavulanate is appropriate. Alternatives include cefuroxime, cefpodoxime, or cefdinir.
Antibiotic Treatment
- Amoxicillin is a first-line antibiotic of choice for acute bacterial rhinosinusitis, as stated in 5 and 6.
- Azithromycin has been shown to be as effective as amoxicillin/clavulanic acid in the treatment of acute sinusitis, with a simpler dosage regimen and faster clinical effect, according to 7.
- For patients with a beta-lactam allergy, appropriate antibiotics include doxycycline or a respiratory fluoroquinolone, as mentioned in 5.
Supportive Care
- Saline irrigation, nasal steroids or antihistamines, and decongestants may help reduce the severity of symptoms, as stated in 5.
- Symptomatic relief with analgesics, topical or systemic decongestants, and steam inhalation can also be beneficial, according to 8.
Duration of Treatment
- 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, as mentioned in 4.
- A 3-day course of azithromycin was as effective as a 10-day course of amoxicillin/clavulanic acid in the treatment of acute sinusitis, according to 7.