What treatment should I give to a patient with sinusitis?

From the Guidelines

For sinusitis treatment, I recommend a stepwise approach starting with supportive care, as most cases are viral and resolve within 7-10 days without antibiotics. Begin with saline nasal irrigation 1-2 times daily and over-the-counter analgesics like acetaminophen (500-1000mg every 6 hours as needed) or ibuprofen (400-600mg every 6-8 hours with food) for pain and inflammation, as suggested by 1. Intranasal corticosteroids such as fluticasone (1-2 sprays per nostril daily) can reduce inflammation. Some key points to consider in the treatment of sinusitis include:

• The use of antibiotics should be reserved for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving, as recommended by 1.
• First-line antibiotic therapy is typically amoxicillin-clavulanate (875/125mg twice daily for 5-7 days) or, for penicillin-allergic patients, doxycycline (100mg twice daily for 5-7 days), as indicated by 1.
• Patients should stay hydrated, rest adequately, and consider using a humidifier to keep nasal passages moist.
• If symptoms don't improve with treatment or recur frequently, referral to an ENT specialist may be necessary to rule out anatomical issues or chronic sinusitis, as suggested by 1. It's also important to note that the impact of antibiotic resistance on outcomes in patients treated with antibiotics for sinusitis is difficult to estimate, and more studies are needed to assess this, as mentioned in 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)]. Clarithromycin tablets, USP and clarithromycin for oral suspension, USP are indicated for the treatment of mild to moderate infections caused by susceptible isolates of the designated bacteria in the conditions as listed below: ... Acute maxillary sinusitis due to Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae

Treatment Options for Sinusitis:

• Levofloxacin tablets can be used to treat acute bacterial sinusitis (ABS) due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis 2.
• Clarithromycin tablets or oral suspension can be used to treat acute maxillary sinusitis due to Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae 3. Key Considerations:
• The choice of treatment should be based on the severity of the infection and the susceptibility of the causative bacteria.
• It is essential to consider local epidemiology and susceptibility patterns when selecting empiric therapy.
• Culture and susceptibility testing should be performed before treatment to guide therapy and reduce the development of drug-resistant bacteria.

From the Research

Treatment Options for Sinusitis

• The treatment for sinusitis depends on the severity and duration of symptoms, as well as the presence of any underlying conditions 4, 5.
• For acute bacterial sinusitis, antibiotics such as amoxicillin or amoxicillin-clavulanate may be prescribed 4.
• In cases of penicillin allergy or resistance, alternative antibiotics such as cefuroxime, cefpodoxime, or cefdinir may be used 4.
• For patients with serious drug allergies, clarithromycin or azithromycin may be prescribed 4.

Duration of Antibiotic Therapy

• The optimal duration of antibiotic therapy for sinusitis is unknown, but most guidelines recommend a 10- to 14-day treatment course 4, 6.
• However, some studies suggest that shorter courses of antibiotic therapy (less than 5 days) may be effective for uncomplicated acute maxillary sinusitis in adults 6.
• The effectiveness of antibiotics in real-life treatment settings has been demonstrated, with antibiotics reducing the risk of failure within 10 days by 3.3-fold 7.

Symptomatic Relief

• Symptomatic relief with analgesics, topical or systemic decongestants, and steam inhalation may be recommended for patients with mild symptoms 5, 8.
• Patients with chronic sinusitis may require long-term use of topical corticosteroids, mast cell stabilizers, or antihistamines to control rhinitis and improve ventilation and function of the sinuses 8.

Special Considerations

• Patients with poor oro-dental condition or recent antibiotic use may derive the most benefit from an antibiotic prescription 7.
• Sinusitis in children, patients with dental disease, and immunosuppressed patients require special consideration 8.
• Complications of acute and chronic sinusitis, such as intraorbital and intracranial sepsis, require urgent evaluation and treatment with broad-spectrum antibiotics and surgical drainage as needed 8.