What is the recommended treatment for maxillary sinusitis?

Treatment of Maxillary Sinusitis

Amoxicillin-clavulanate is the first-line treatment for maxillary sinusitis, with 875/125 mg twice daily for 5-7 days being the recommended regimen. 1

Antibiotic Selection

First-line Treatment

• Amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days)
  • Provides excellent coverage against common pathogens including Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis
  • Clinical success rates of 93-98% have been demonstrated 2, 3

Alternative Options (for penicillin allergy or treatment failure)

• Non-anaphylactic penicillin allergy:

  • Cefuroxime (500 mg twice daily for 5-7 days) 1
  • Cefpodoxime (200-400 mg twice daily for 5-7 days) 1
  • Cefdinir (14 mg/kg/day divided once or twice daily for 5-7 days) 1

• Severe penicillin allergy:

  • Respiratory fluoroquinolones (e.g., levofloxacin 750 mg daily for 5 days) 1, 4
  • Levofloxacin has demonstrated 91.4% clinical success rates in acute bacterial sinusitis 4

Treatment Duration

• Standard duration is 5-7 days for most cases with newer agents 1
• For more severe cases, therapy should continue until 7 days after symptom resolution 1

Special Considerations

Dental Origin

• Maxillary sinusitis of dental origin always requires antibiotic therapy 1
• May need longer treatment duration and consideration of anaerobic coverage

Treatment Failure

• If no improvement after 72 hours of initial therapy:
  • Reassess diagnosis
  • Consider switching to a respiratory fluoroquinolone (levofloxacin or moxifloxacin) 1
  • Consider combination therapy with clindamycin plus cefixime 1

Adjunctive Therapies

1. Intranasal corticosteroids

   • Recommended for symptom relief 1
   • May be more effective in patients with less severe symptoms 5

2. Intranasal saline irrigation

   • Helps clear secretions and reduce inflammation 1

3. Analgesics

   • Acetaminophen or NSAIDs for pain management 1

4. Decongestants

   • May provide short-term symptom relief
   • Not recommended for prolonged use (>3-5 days)

Monitoring and Follow-up

• Patients should follow up if symptoms persist beyond 72 hours of treatment 1
• Consider referral to otolaryngology if:
  • Multiple treatment failures
  • Complications suspected (orbital, intracranial)
  • Immunocompromised patient
  • Nosocomial sinusitis

Common Pitfalls to Avoid

1. Overuse of antibiotics for viral sinusitis - ensure bacterial etiology before prescribing
2. Inadequate duration of therapy leading to relapse (reported in 7.7% of cases) 6
3. Failure to consider resistant pathogens in treatment failures
4. Missing dental sources of infection which require specific management
5. Overlooking complications such as orbital or intracranial extension, particularly with ethmoid sinusitis 1

For maxillary sinusitis, restoring normal sinus drainage is crucial for resolution. While some older studies suggested sinus puncture and lavage 7, current guidelines favor medical management with appropriate antibiotics and adjunctive therapies as the primary approach.