What are the recommended medications for treating sinus infections?

Recommended Medications for Treating Sinus Infections

Amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days) is the first-line treatment for bacterial sinusitis, with high-dose amoxicillin-clavulanate or respiratory fluoroquinolones recommended for patients who have received antibiotics in the previous 4-6 weeks or have moderate disease. 1

First-Line Treatment Options

For Patients WITHOUT Recent Antibiotic Use (Past 4-6 Weeks) with Mild Disease:

• Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days 1
• Alternative: Amoxicillin 1.5-4 g/day 1

For Patients WITH Recent Antibiotic Use (Past 4-6 Weeks) or Moderate Disease:

• High-dose amoxicillin-clavulanate (4 g/250 mg per day) 1
• Respiratory fluoroquinolones (e.g., levofloxacin 750 mg once daily for 5 days) 1, 2

Alternative Options for Penicillin-Allergic Patients

Cephalosporin Options (if non-anaphylactic allergy):

• Cefuroxime (500 mg twice daily) 1
• Cefpodoxime (200-400 mg twice daily) 1
• Cefdinir (300-600 mg twice daily) 1

Non-Beta-Lactam Options (for true penicillin allergy):

• Doxycycline 1
• Trimethoprim-sulfamethoxazole 1
• Macrolides (e.g., azithromycin 500 mg on day 1, then 250 mg daily for 4 days) 1, 3
  • Note: Macrolides have bacteriologic failure rates of 20-25% 1

Treatment Duration and Monitoring

• Standard treatment duration: 5-7 days for uncomplicated cases 1
• For severe cases: Continue until symptom-free plus an additional 7 days 1
• Reassess treatment response after 72 hours 1
  • If no improvement, consider:
    • Alternative diagnosis
    • Resistant pathogens
    • Need for imaging or specialist referral

Adjunctive Therapies

The following can provide symptom relief alongside antibiotic therapy:

• Intranasal corticosteroids 1
• Intranasal saline irrigation 1
• Decongestants (to improve sinus drainage) 1
• Analgesics for pain relief 1

Common Pitfalls to Avoid

1. Treating viral URI as bacterial sinusitis - Ensure diagnosis meets criteria for bacterial sinusitis 1
2. Using fluoroquinolones as first-line therapy - Reserve for specific situations 1
3. Inadequate treatment duration - Follow recommended 5-7 day course 1
4. Failing to reassess after 72 hours - Important to evaluate treatment response 1
5. Using macrolides as first-line therapy - High failure rates (20-25%) 1

Special Considerations

• Resistant organisms risk factors: Recent antibiotic use, daycare attendance, areas with high prevalence of resistant S. pneumoniae, and severe symptoms 1
• Immunocompromised patients are at higher risk for complicated sinusitis 1
• While a recent study showed no benefit of high-dose versus standard-dose amoxicillin-clavulanate 4, guidelines still recommend high-dose for patients with risk factors for resistant organisms 1

Remember that proper diagnosis of bacterial sinusitis is crucial before initiating antibiotic therapy, as many cases of sinusitis are viral in origin and do not require antibiotics.