What is the recommended medication for acute maxillary sinusitis?

Medication Treatment for Acute Maxillary Sinusitis

Amoxicillin-clavulanate is the recommended first-line antibiotic treatment for acute maxillary sinusitis due to its coverage of the most common bacterial pathogens including beta-lactamase producing strains. 1

First-Line Antibiotic Options

Preferred Treatment

• Amoxicillin-clavulanate
  • Standard dose: 875/125 mg twice daily for 5-7 days 1
  • High-dose: 2000 mg (amoxicillin component) with 125 mg clavulanate twice daily for 5-7 days (for areas with high prevalence of resistant organisms) 1

Alternative First-Line (for non-severe cases)

• Amoxicillin alone
  • 500 mg three times daily for 5-7 days 1
  • The American Academy of Pediatrics allows either amoxicillin or amoxicillin-clavulanate as first-line therapy 2

For Penicillin-Allergic Patients

• Cephalosporins (if no history of anaphylaxis to penicillin)

  • Cefdinir: 300-600 mg twice daily for 5-7 days 1
  • Cefuroxime: 250-500 mg twice daily for 5-7 days 1
  • Cefpodoxime: 200-400 mg twice daily for 5-7 days 1

• Fluoroquinolones (reserved for patients with severe allergy or treatment failures)

  • Levofloxacin: 500 mg once daily for 5-7 days 1, 3
  • Moxifloxacin: 400 mg once daily for 5-7 days 1

Adjunctive Therapies

1. Intranasal corticosteroids

   • Helps reduce inflammation and promote drainage
   • Particularly beneficial for patients with concurrent allergic rhinitis 1

2. Saline nasal irrigation

   • Helps clear mucus and reduce inflammation
   • Safe for prolonged use 1

3. Nasal decongestants

   • Can be used for up to 5 days to reduce congestion
   • Caution: risk of rhinitis medicamentosa with prolonged use 1

Treatment Duration and Follow-up

• Treatment duration: 5-7 days for most uncomplicated cases 1
• Assessment: Patients should be reassessed within 72 hours if symptoms worsen or fail to improve 1
• Treatment failure: Consider switching to a broader-spectrum antibiotic if no improvement after 72 hours 1

Special Considerations

• For unilateral maxillary sinusitis, evaluate for possible dental infection 1
• Signs of complicated sinusitis (meningeal syndrome, exophthalmos, palpebral edema, ocular mobility disorders, severe pain) require hospitalization and parenteral antibiotics 1
• Imaging studies are not recommended for routine diagnosis but may be needed if complications are suspected 1

Clinical Evidence Notes

Research has shown that amoxicillin-clavulanate given every 12 hours (875/125 mg) is as effective as administration every 8 hours (500/125 mg) for acute bacterial maxillary sinusitis, with similar safety profiles 4. However, amoxicillin-clavulanate is associated with more gastrointestinal side effects compared to some alternatives like cefuroxime axetil 5.

A 2007 randomized controlled trial questioned the effectiveness of antibiotics for acute maxillary sinusitis in primary care settings, finding that neither amoxicillin nor topical budesonide alone or in combination was significantly more effective than placebo 6. However, current guidelines still recommend antibiotic therapy for cases with clear bacterial etiology, particularly those with severe symptoms or risk factors for complications.

The choice between amoxicillin alone versus amoxicillin-clavulanate should consider local resistance patterns, with amoxicillin-clavulanate preferred in areas with high prevalence of beta-lactamase producing organisms like H. influenzae and M. catarrhalis 1, 2.