What is the treatment for acute bacterial sinusitis?

From the Guidelines

The treatment for acute bacterial sinusitis typically involves antibiotics, with amoxicillin being the first-line treatment, and supportive measures such as saline nasal irrigation, pain relievers, and intranasal corticosteroids to reduce inflammation and improve symptoms.

Key Considerations

• The diagnosis of acute bacterial sinusitis is made when a child with an acute upper respiratory tract infection presents with persistent illness, worsening course, or severe onset 1.
• Amoxicillin with or without clavulanate is the first-line treatment of acute bacterial sinusitis, with a recommended dose of 45 mg/kg per day in 2 divided doses for children aged 2 years or older with uncomplicated acute bacterial sinusitis that is mild to moderate in degree of severity 1.
• For patients with penicillin allergies, alternatives include cefdinir, cefuroxime, or cefpodoxime 1.
• Supportive measures are important alongside antibiotics, including saline nasal irrigation, over-the-counter pain relievers like acetaminophen or ibuprofen, and intranasal corticosteroids such as fluticasone to reduce inflammation.
• Staying hydrated and using a humidifier can help thin mucus, and most bacterial sinus infections improve within 7-10 days of starting antibiotics.

Management Approach

• Clinicians should reassess initial management if there is either a caregiver report of worsening or failure to improve within 72 hours of initial management 1.
• If the diagnosis of acute bacterial sinusitis is confirmed in a child with worsening symptoms or failure to improve, then clinicians may change the antibiotic therapy for the child initially managed with antibiotic or initiate antibiotic treatment of the child initially managed with observation.
• A single 50-mg/kg dose of ceftriaxone can be used for children who are vomiting, unable to tolerate oral medication, or unlikely to be adherent to the initial doses of antibiotic, with the option to switch to oral therapy after clinical improvement 1.

From the FDA Drug Label

1.4 Acute Bacterial Sinusitis: 5 Day and 10 to 14 Day Treatment Regimens Levofloxacin tablets are indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis

14.4 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

The treatment for acute bacterial sinusitis is levofloxacin 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days, for infections caused by Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis 2. Alternatively, moxifloxacin may also be used for the treatment of acute bacterial sinusitis (ABS) caused by susceptible isolates of Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis 3.

From the Research

Treatment Options for Acute Bacterial Sinusitis

The treatment for acute bacterial sinusitis typically involves the use of antibiotics, with the goal of resolving the infection and alleviating symptoms. The following are some of the treatment options:

• Antibiotic therapy: Narrow-spectrum antibiotics such as amoxicillin should be used for 10 to 14 days 4
• Alternative antibiotics: In patients with mild disease who have beta-lactam allergy, trimethoprim/sulfamethoxazole or doxycycline are options 4
• Second-line antibiotics: Amoxicillin-clavulanate potassium and fluoroquinolones have the best coverage for Haemophilus influenzae and Streptococcus pneumoniae 4
• Decongestants: Often recommended, and there is some evidence to support their use, although topical decongestants should not be used for more than three days to avoid rebound congestion 4

Dosage and Administration

The dosage and administration of antibiotics for acute bacterial sinusitis can vary:

• Standard-dose amoxicillin/clavulanate: 875/125 mg every 12 hours or every 8 hours 5
• High-dose amoxicillin/clavulanate: 2000 mg of extended-release amoxicillin with 125 mg of immediate-release clavulanate twice a day, or 1750 mg of immediate-release amoxicillin twice a day 6, 7
• Cefdinir: 600 mg once a day for 10 days or 300 mg twice a day for 10 days 8

Efficacy and Safety

The efficacy and safety of different antibiotic regimens for acute bacterial sinusitis have been studied:

• High-dose versus standard-dose amoxicillin/clavulanate: No significant difference in efficacy was found in one study 6, while another study found that adults with clinically diagnosed acute bacterial sinusitis were more likely to improve rapidly when treated with high-dose amoxicillin/clavulanate 7
• Cefdinir versus amoxicillin-clavulanate: Cefdinir was found to be as effective as amoxicillin-clavulanate in the treatment of acute community-acquired bacterial sinusitis 8