From the Guidelines
For chronic sinusitis, amoxicillin-clavulanate (Augmentin) is the most effective antibiotic treatment, typically prescribed at 875/125 mg twice daily for a minimum of 3 weeks. This recommendation is based on the most recent and highest quality evidence available, which suggests that a minimum of 3 weeks of treatment with an antibiotic effective against H influenzae, mouth anaerobes, and S pneumoniae is efficacious 1. The use of amoxicillin-clavulanate is supported by its broad-spectrum activity against common bacterial pathogens in chronic sinusitis, including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus, including those that produce beta-lactamase.
Key Considerations
- The role of bacterial infection and the importance of antibiotic therapy in chronic sinusitis are controversial, but the use of antibiotics such as amoxicillin-clavulanate has been shown to be effective in reducing symptoms and improving quality of life 1.
- Alternatives for penicillin-allergic patients include doxycycline (100 mg twice daily) or a respiratory fluoroquinolone like levofloxacin (500 mg once daily), but these options should be considered on a case-by-case basis 2.
- Treatment should be accompanied by saline nasal irrigation and possibly intranasal corticosteroids to reduce inflammation, as these adjunctive therapies have been shown to provide symptomatic benefit in selected cases 2.
- If symptoms don't improve after 3-5 days, or worsen at any point, medical reassessment is necessary to consider alternative treatments or further evaluation, such as culture-directed therapy based on endoscopic sampling 2.
Additional Factors to Consider
- Chronic sinusitis often has multiple contributing factors beyond bacterial infection, including allergies, anatomical issues, or fungal elements, so comprehensive management may require additional treatments 1, 2.
- Consultation with a specialist should be sought when sinusitis is refractory to usual antibiotic treatment, recurrent, or significantly affects performance and quality of life, or when concomitant conditions are present that complicate assessment or treatment 2.
From the Research
Effective Antibiotics for Chronic Sinusitis
- The most effective antibiotic for chronic sinusitis is not clearly established, but several studies have compared the efficacy of different antibiotics 3, 4, 5, 6.
- A study published in 1994 found that ciprofloxacin was as effective as amoxicillin-clavulanate in treating chronic sinusitis, with a clinical cure rate of 58.6% versus 51.2% and a bacteriological eradication rate of 88.9% versus 90.5% 3.
- Another study published in 2017 found that amoxicillin-clavulanate did not change the clinical course of acute exacerbation of chronic rhinosinusitis compared to placebo, despite the majority of bacteria being sensitive to the antibiotic 4.
- A 2018 study compared high-dose versus standard-dose amoxicillin/clavulanate for acute bacterial sinusitis and found that adults were more likely to improve rapidly when treated with high-dose amoxicillin/clavulanate, but not without an increased risk of severe diarrhea 5.
- However, a 2021 study found that high-dose amoxicillin plus clavulanate was not superior to standard-dose amoxicillin plus clavulanate in adults with acute sinusitis, with no significant difference in global rating of improvement or adverse effects 6.
Comparison of Antibiotics
- Amoxicillin-clavulanate is commonly used to treat chronic sinusitis, but its efficacy has been questioned in some studies 4, 6.
- Ciprofloxacin has been shown to be effective in treating chronic sinusitis, with a favorable safety profile and twice-daily dosage regimen 3.
- High-dose amoxicillin/clavulanate may be more effective than standard-dose in some cases, but it also increases the risk of severe diarrhea 5.