Treatment of Sinus Infections
For acute bacterial sinusitis, amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days) is the recommended first-line antibiotic treatment, with intranasal corticosteroids as an important adjunctive therapy. 1
Distinguishing Viral vs. Bacterial Sinusitis
- Most cases of acute sinusitis (duration <3 weeks) are caused by viral infections 2
- Consider bacterial sinusitis if:
- Symptoms persist >7-10 days without improvement
- Severe symptoms (high fever, purulent nasal discharge for 3-4 consecutive days)
- Worsening symptoms after initial improvement 3
First-Line Treatment Recommendations
Antibiotic Therapy
For patients without recent antibiotic use (past 4-6 weeks) and mild disease:
- Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days 1
For patients with recent antibiotic use or moderate disease:
For Penicillin-Allergic Patients
Non-anaphylactic allergy:
- Cefuroxime (500 mg twice daily)
- Cefpodoxime (200-400 mg twice daily)
- Cefdinir (300-600 mg twice daily) 1
True anaphylactic allergy:
Adjunctive Therapies
- Intranasal corticosteroids: Recommended alongside antibiotics - shown to reduce symptoms more effectively than antibiotics alone 5
- Nasal saline irrigation: Helps clear secretions and improve symptoms
- Decongestants: May help with sinus drainage, but limited to 3-5 days to avoid rebound congestion 2
- Analgesics: For pain relief as needed
Treatment Duration and Assessment
- Reassess treatment response after 72 hours 1
- Standard treatment duration: 5-7 days for uncomplicated cases 1
- For more severe cases: continue until symptom-free plus an additional 7 days 1
Special Considerations
Common Pathogens
- Most common bacteria in acute sinusitis:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis 6
Risk Factors for Resistant Organisms
- Recent antibiotic use
- Areas with high prevalence of resistant S. pneumoniae
- Severe or worsening symptoms 1
Common Pitfalls to Avoid
- Treating viral URI as bacterial sinusitis (most cases resolve spontaneously within 7-10 days) 7
- Using fluoroquinolones as first-line therapy (reserve for specific situations)
- Inadequate duration of therapy
- Not reassessing after 72 hours of treatment 1
- Overuse of decongestants (>5 days can lead to rebound congestion)
When to Consider Specialist Referral
- Failure to respond to multiple antibiotic courses
- Recurrent acute sinusitis (≥4 episodes per year)
- Complications (orbital, intracranial)
- Anatomic abnormalities requiring surgical evaluation 2
Real-world data shows that while most untreated acute sinusitis cases resolve spontaneously (88.7%), appropriate antibiotic therapy increases resolution rates to 96.2% within 10 days 7, making proper treatment selection important for reducing morbidity and improving quality of life.