From the Guidelines
Treatment for bacterial sinusitis typically involves antibiotics, with amoxicillin being the first-line choice, as recommended by the American Academy of Pediatrics 1. The standard dose of amoxicillin for children is not specified in the provided evidence, but for adults, it is typically 500 mg three times daily or 875 mg twice daily for 5-10 days. For patients with penicillin allergies, alternatives include cefdinir, cefuroxime, or cefpodoxime, as suggested by the American Academy of Pediatrics 1. If symptoms are severe or there's no improvement after 48-72 hours, broader-spectrum antibiotics like amoxicillin-clavulanate may be needed. Alongside antibiotics, supportive measures are important, including:
- Saline nasal irrigation
- Over-the-counter pain relievers like acetaminophen or ibuprofen for pain and inflammation
- Nasal decongestants (limited to 3 days to avoid rebound congestion) Staying hydrated and using warm compresses on the face can help relieve pressure. Antibiotics work by targeting the bacterial infection causing the inflammation of the sinus cavities, while supportive treatments help manage symptoms and promote drainage of mucus from the sinuses. It's essential to note that the diagnosis of acute bacterial sinusitis is made when a child presents with persistent illness, worsening course, or severe onset, as defined by the American Academy of Pediatrics 1. In cases where the diagnosis is confirmed, and the patient is not improving, the antibiotic therapy may need to be changed or initiated, as recommended by the American Academy of Pediatrics 1. Additionally, adjuvant therapy, such as intranasal corticosteroids, saline nasal irrigation, or topical decongestants, may be considered, although the evidence for their effectiveness is limited, as noted by the American Academy of Pediatrics 1.
From the FDA Drug Label
1.4 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
1.6 Acute Bacterial Sinusitis Moxifloxacin hydrochloride tablets are indicated in adult patients (18 years of age and older) for the treatment of acute bacterial sinusitis (ABS) caused by susceptible isolates of Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis
The treatment for bacterial sinusitis is levofloxacin or moxifloxacin.
- Levofloxacin can be administered as 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days.
- Moxifloxacin is also an option for the treatment of acute bacterial sinusitis. It is recommended to use these antibiotics only when the infection is proven or strongly suspected to be caused by susceptible bacteria 2, 2, 3.
From the Research
Treatment Options for Bacterial Sinusitis
- The treatment for acute bacterial sinusitis (ABS) typically involves the use of antibiotics, with the goal of reducing symptoms and preventing complications 4, 5.
- The choice of antibiotic depends on various factors, including the severity of symptoms, patient allergies, and the likelihood of antibiotic resistance 4, 5.
- Commonly used antibiotics for ABS include:
- The optimal duration of antibiotic therapy is unknown, but treatment is typically continued until the patient becomes free of symptoms and then for an additional 7-10 days 4, 5, 6.
Dosage and Efficacy
- High-dose amoxicillin-clavulanate may be more effective than standard-dose therapy in some cases, but the evidence is mixed 8, 7.
- A study comparing 5-day and 10-day courses of gatifloxacin found similar clinical cure rates and tolerability to those of standard 10-day therapy with amoxicillin-clavulanate 6.
- Another study found that high-dose amoxicillin plus clavulanate was not superior to standard-dose therapy in adults with acute sinusitis 7.