From the Guidelines
Ciprofloxacin (Cipro) is not the first-line treatment for acute bacterial sinusitis.
Rationale
- The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 1 does not specifically recommend ciprofloxacin as a first-line treatment for acute bacterial sinusitis.
- According to the Journal of Allergy and Clinical Immunology 1, ciprofloxacin has a specific indication for the treatment of sinusitis in adults, but its use is generally reserved for protracted or severe cases.
- The study by Legent et al. 1 compared ciprofloxacin to amoxicillin-clavulanate in patients with chronic rhinosinusitis and found similar clinical cure rates, but this study did not specifically focus on acute bacterial sinusitis.
- The Journal of Allergy and Clinical Immunology 1 recommends other antibiotics, such as amoxicillin-clavulanate, as first-line treatments for acute bacterial sinusitis.
Key Points
- Ciprofloxacin may be considered for treatment of sinusitis in adults, but it is not the first-line treatment.
- Amoxicillin-clavulanate is generally recommended as a first-line treatment for acute bacterial sinusitis.
- The duration of antibiotic therapy for sinusitis is typically 10-14 days, but may be extended until symptoms resolve plus 7 days.
- If there is no clinical improvement within 3 days of initiating antimicrobial therapy, an alternative antibiotic should be considered 1.
From the FDA Drug Label
Acute Sinusitis caused by Haemophilus influenzae, penicillin-susceptible Streptococcus pneumoniae, or Moraxella catarrhalis Yes, ciprofloxacin (Cipro) is indicated for the treatment of acute bacterial sinusitis caused by specific microorganisms, including:
- Haemophilus influenzae
- Penicillin-susceptible Streptococcus pneumoniae
- Moraxella catarrhalis 2
From the Research
Efficacy of Ciprofloxacin in Acute Bacterial Sinusitis
- Ciprofloxacin has been shown to be effective in the treatment of acute bacterial sinusitis, with clinical success rates similar to those of cefuroxime axetil 3, 4.
- The most commonly isolated pathogens in acute bacterial sinusitis, including Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and Staphylococcus aureus, are susceptible to ciprofloxacin 3, 4.
- Ciprofloxacin has been demonstrated to be as effective as cefuroxime axetil in the treatment of community-acquired acute sinusitis, with similar clinical and bacteriologic response rates 3.
Comparison with Other Antibiotics
- Ciprofloxacin has been compared to amoxycillin/clavulanic acid in the treatment of chronic sinusitis, and was found to be at least as effective, with a superior safety profile 5.
- However, the use of ciprofloxacin in the treatment of acute bacterial sinusitis may be associated with adverse effects such as arthralgias and myalgias, which can be severe enough to require discontinuation of therapy 6.
Topical vs. Systemic Administration
- The efficacy of topical ciprofloxacin/dexamethasone in the treatment of acute Streptococcus pneumoniae rhinosinusitis in mice has been investigated, and was found to have no significant effect on the course of the illness 7.
- This suggests that topical administration of ciprofloxacin may not be effective in the treatment of acute bacterial sinusitis, and that systemic administration may be necessary to achieve adequate tissue concentrations of the antibiotic.