From the Guidelines
For bacterial sinusitis, amoxicillin-clavulanate is the preferred first-line antibiotic treatment, typically prescribed as 875/125 mg twice daily for 5-7 days in adults with uncomplicated cases. This recommendation is based on the evidence from the American College of Physicians and the Centers for Disease Control and Prevention, which suggests that amoxicillin-clavulanate is effective against the most common pathogens in bacterial sinusitis, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, including beta-lactamase producing strains 1.
Some key points to consider when treating bacterial sinusitis include:
- Treatment should be initiated when symptoms persist beyond 10 days, are severe (high fever, purulent discharge) for 3-4 days, or worsen after initial improvement.
- Supportive measures like saline irrigation, nasal decongestants (for up to 3 days), and analgesics can help manage symptoms while antibiotics address the underlying infection.
- If symptoms don't improve after 3-5 days of treatment, reevaluation is necessary to consider alternative diagnoses or antibiotic resistance.
- For patients with penicillin allergies, alternatives include doxycycline (100 mg twice daily), levofloxacin (500 mg once daily), or moxifloxacin (400 mg once daily) 1.
- In children, amoxicillin-clavulanate is dosed by weight, usually 45 mg/kg/day divided twice daily 1.
It's also important to note that acute uncomplicated rhinosinusitis is a self-limited infection that usually resolves without antibiotics, even in patients with a bacterial cause, and most patients diagnosed with acute rhinosinusitis have more adverse effects than benefits from antibiotics 1. Therefore, watchful waiting (without antibiotic therapy) as initial management for all patients with uncomplicated ABRS, regardless of severity, is also a viable option 1.
From the FDA Drug Label
Acute Bacterial Sinusitis: 5 Day and 10 to 14 Day Treatment Regimens Levofloxacin tablets are indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis
Acute bacterial sinusitis500 mg QD × 3 days
The preferred antibiotics for Acute Bacterial Sinusitis are:
- Azithromycin (500 mg QD × 3 days)
- Levofloxacin (treatment regimens of 5,7,10 or 14 days)
- Amoxicillin/clavulanate (500/125 mg tid for 10 days) 2 3
Key pathogens for Acute Bacterial Sinusitis include:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
From the Research
Preferred Antibiotics for Acute Bacterial Sinusitis
The following antibiotics are preferred for the treatment of acute bacterial sinusitis:
- High-dose amoxicillin or amoxicillin-clavulanate 4
- Cefuroxime, cefpodoxime, or cefdinir as alternatives 4
- Clarithromycin or azithromycin in cases of serious drug allergy 4
- Respiratory fluoroquinolones (e.g., moxifloxacin, gatifloxacin, and levofloxacin) as second-line therapy or for selected patients 5
- Ceftriaxone as an alternative 5
Treatment Duration and Efficacy
- The optimal duration of therapy is unknown, but treatment until the patient becomes free of symptoms and then for an additional 7 days is recommended 4
- Azithromycin has been shown to be equivalent in efficacy to amoxicillin-clavulanate, with a faster resolution of symptoms and a simpler dosage regimen 6, 7
- Fluoroquinolones have been compared to beta-lactam antibiotics in several studies, with no significant difference in clinical cure rates, but with a higher chance of clinical success among clinically evaluable patients 8