What is the recommended antibiotic treatment for acute bacterial sinusitis?

Recommended Antibiotic Treatment for Acute Bacterial Sinusitis

Amoxicillin-clavulanate is the first-line antibiotic treatment for acute bacterial sinusitis, with a dosage of 875/125 mg twice daily for 5-7 days in adults. 1

Diagnosis of Acute Bacterial Sinusitis

Before initiating antibiotic therapy, confirm the diagnosis of acute bacterial sinusitis based on one of these clinical presentations:

• Persistent symptoms: Nasal discharge or cough for >10 days without improvement
• Severe symptoms: High fever (≥39°C/102.2°F) with purulent nasal discharge for ≥3 consecutive days
• Worsening symptoms: Initial improvement followed by worsening nasal discharge, cough, or fever 1

First-Line Antibiotic Treatment

• Amoxicillin-clavulanate: 875/125 mg twice daily for 5-7 days 1
  • Preferred over amoxicillin alone due to increasing prevalence of beta-lactamase-producing organisms
  • In areas with low resistance patterns, amoxicillin 500-875 mg three times daily for 5-7 days may be used 1
  • For severe infections or high-risk patients, consider high-dose amoxicillin-clavulanate (2000 mg amoxicillin component with 125 mg clavulanate twice daily) 1

Alternative Antibiotic Options

For patients with penicillin allergy:

• Non-severe penicillin allergy:

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

• Severe penicillin allergy:

  • Levofloxacin: 500 mg once daily for 5-7 days 1, 2
  • Moxifloxacin: 400 mg once daily for 5-7 days 1, 3
  • Doxycycline (alternative for fluoroquinolone-contraindicated patients) 1

Treatment Duration

• Standard duration: 5-7 days for uncomplicated cases in adults 1
• Extended duration: 10-14 days may be considered for severe or complicated cases 1

Adjunctive Treatments

In addition to antibiotics, consider:

• Intranasal corticosteroids to reduce inflammation
• Saline nasal irrigation to clear mucus (safe for prolonged use)
• Short-term nasal decongestants (≤3 days to avoid rebound congestion) 1

Monitoring and Follow-up

• Assess for clinical improvement within 72 hours of starting antibiotics
• If no improvement after 72 hours, consider switching to a broader-spectrum antibiotic
• Refer to an otolaryngologist if symptoms persist despite appropriate antibiotic therapy and adjunctive treatments 1

Warning Signs for Complications

Immediate specialist referral is required for:

• Orbital involvement (periorbital edema, limited eye movement)
• Severe headache or altered mental status
• Persistent high fever despite antibiotic therapy 1

Special Considerations

• Fluoroquinolones (levofloxacin, moxifloxacin) should be reserved for patients with no alternative treatment options due to potential serious adverse reactions 2, 3
• Levofloxacin is FDA-approved for acute bacterial sinusitis in both 5-day and 10-14 day treatment regimens 2
• Recent research has not shown benefit of high-dose versus standard-dose amoxicillin-clavulanate for acute sinusitis 4

Remember that appropriate diagnosis is critical before initiating antibiotics, as many cases of sinusitis are viral and do not require antibiotic treatment.