What is the treatment for Acute Sinusitis?

From the Guidelines

Acute Sinusitis treatment typically involves a 5-day course of antibiotics, such as amoxicillin-clavulanate, for patients with a confirmed bacterial cause.

Key Considerations

• The choice of antibiotic should be based on predicted efficacy, cost, and side effects, with amoxicillin-clavulanate being a preferred agent 1.
• A 5-day course of antibiotics has been shown to be as effective as a 10-day course, with fewer adverse events 1.
• Patients with acute uncomplicated rhinosinusitis should be managed with supportive care, including analgesics and antipyretics, with antibiotics only being considered for patients with a confirmed bacterial cause 1.
• Adjunctive therapy, such as intranasal saline irrigation or intranasal corticosteroids, may be used to alleviate symptoms and potentially decrease antibiotic use 1.

Antibiotic Options

• Amoxicillin-clavulanate is a commonly prescribed antibiotic for acute bacterial sinusitis, with a dose of 90 mg/kg/d in 2 divided doses (maximum dose of amoxicillin is 1.0 g every 12 hours) 1.
• Other options include doxycycline or a respiratory fluoroquinolone, which may be used as an alternative in patients with acute bacterial sinusitis 1.

Important Notes

• Antibiotic treatment should only be considered for patients with a confirmed bacterial cause of acute sinusitis, as viral upper respiratory tract infections are common and do not require antibiotic treatment 1.
• The diagnosis of acute sinusitis should be based on clinical criteria, including symptoms such as nasal congestion, purulent rhinorrhea, facial-dental pain, and headache 1.

From the Research

Treatment Options for Acute Sinusitis

The treatment for acute sinusitis typically involves a combination of antibiotics and symptomatic relief measures. The choice of antibiotic therapy depends on the severity of the symptoms and the likelihood of bacterial infection.

• Antibiotic therapy is usually recommended for patients with severe symptoms or those who have not responded to symptomatic treatment after 7-10 days 2, 3, 4, 5, 6.
• The most commonly recommended antibiotics for acute sinusitis are amoxicillin, amoxicillin-clavulanate, cefuroxime, cefpodoxime, and cefdinir 2, 3, 4, 5, 6.
• For patients with penicillin allergy, alternatives such as clarithromycin or azithromycin may be prescribed 6.
• The optimal duration of antibiotic therapy is unknown, but studies suggest that a 5-7 day course may be as effective as a 10-14 day course in some cases 2, 3.

Symptomatic Relief Measures

In addition to antibiotic therapy, symptomatic relief measures may be used to help manage the symptoms of acute sinusitis.

• Decongestants and pain medications may be used to relieve nasal congestion and headache 4.
• Saline nasal sprays or irrigations may also be used to help loosen and clear mucus from the nasal passages 4.
• In some cases, adjunctive treatments such as fluticasone propionate may be used in addition to antibiotics to help reduce inflammation and improve symptoms 4.

Special Considerations

Certain patient populations may require special consideration when it comes to treating acute sinusitis.

• Patients with poor oro-dental condition or recent antibiotic use may derive the most benefit from antibiotic therapy 5.
• Patients with severe symptoms or complicating factors may require longer courses of antibiotic therapy or more intensive treatment 2, 3, 4, 5, 6.