From the Guidelines
Acute sinusitis treatment should prioritize symptom management with supportive care, reserving antibiotics for severe or persistent cases, as most cases are viral and self-limiting. For symptom relief, consider the following:
- Nasal saline irrigation 1-2 times daily to promote drainage and reduce congestion
- Over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours as needed) or ibuprofen (400-600mg every 6-8 hours with food) to manage pain and fever
- Intranasal corticosteroids such as fluticasone (1-2 sprays per nostril daily) to reduce inflammation
- Oral decongestants like pseudoephedrine (30-60mg every 4-6 hours, not exceeding 240mg daily) to alleviate congestion
According to the American College of Physicians and the Centers for Disease Control and Prevention 1, most patients with acute rhinosinusitis should be managed with supportive care, and antibiotics should be reserved for patients with persistent symptoms or severe cases. The American Academy of Otolaryngology–Head and Neck Surgery also emphasizes watchful waiting as initial management for all patients with uncomplicated acute bacterial rhinosinusitis (ABRS) 1.
When antibiotics are necessary, amoxicillin (500mg three times daily for 5-7 days) is typically the first-line antibiotic, with amoxicillin-clavulanate (875/125mg twice daily for 5-7 days) used for more severe cases or when resistance is suspected. It is essential to note that the use of antibiotics should be guided by clinical criteria, and the choice of antibiotic should be based on the severity of symptoms and the likelihood of bacterial infection 1.
Additionally, adjunctive treatments such as saline irrigation, intranasal corticosteroids, and mucolytics may provide symptomatic relief, although their effectiveness may vary depending on the individual patient and the specific condition being treated 1.
Overall, the goal of treatment for acute sinusitis is to alleviate symptoms, promote drainage, and prevent complications, while minimizing the unnecessary use of antibiotics and reducing the risk of antibiotic resistance.
From the FDA Drug Label
Acute bacterial sinusitis 500 mg QD × 3 days The treatment for acute sinusitis is azithromycin 500 mg once daily for 3 days 2.
- The recommended dose is the same for adults.
- For pediatric patients, the recommended dose of azithromycin for oral suspension for the treatment of acute bacterial sinusitis is 10 mg/kg once daily for 3 days 2.
From the Research
Treatment Options for Acute Sinusitis
- The treatment for acute sinusitis typically involves antibiotics, with the goal of relieving symptoms and preventing complications 3, 4, 5, 6, 7.
- The choice of antibiotic depends on various factors, including the severity of symptoms, patient age, and presence of allergies or resistance to certain antibiotics 3, 4, 5, 6, 7.
Antibiotic Regimens
- High-dose amoxicillin or amoxicillin-clavulanate is often recommended as the first-line treatment for acute bacterial sinusitis 3, 4, 7.
- Alternative antibiotics, such as cefuroxime, cefpodoxime, or cefdinir, may be used in patients who are allergic to penicillin or have resistance to amoxicillin 3.
- Macrolides, such as clarithromycin or azithromycin, may be used in cases of serious drug allergy 3.
Duration of Therapy
- The optimal duration of antibiotic therapy for acute sinusitis is unknown, but treatment is typically continued until symptoms resolve and for an additional 7-10 days 3, 5.
Symptomatic Relief
- Decongestants and mucoevacuents may be used to relieve symptoms, such as nasal congestion and cough 5, 6.
- Analgesics, such as acetaminophen or ibuprofen, may be used to relieve headache and facial pain 6.