What is the treatment for acute sinusitis?

From the Guidelines

For acute sinusitis, I recommend amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 5-7 days as first-line treatment, as suggested by the American College of Physicians and the Centers for Disease Control and Prevention 1. This treatment approach is based on the most recent and highest quality evidence available, which prioritizes the use of amoxicillin-clavulanate for acute bacterial sinusitis due to its effectiveness, safety, and relatively narrow microbiologic spectrum. If the patient has a penicillin allergy, doxycycline 100 mg twice daily for 5-7 days is an alternative, as recommended by various professional societies, including the American Academy of Allergy, Asthma & Immunology and the American Academy of Family Physicians 1. Nasal saline irrigation and over-the-counter decongestants like pseudoephedrine can help relieve symptoms, while pain relievers such as acetaminophen or ibuprofen can manage discomfort. Most sinus infections are viral and resolve without antibiotics within 7-10 days, so antibiotics are only recommended if symptoms persist beyond 10 days, are severe with high fever (>102°F), or worsen after initial improvement, as stated in the guidelines for acute respiratory tract infection in adults 1. Antibiotics target bacterial overgrowth in the sinuses, while decongestants reduce inflammation and improve drainage. Patients should complete the full antibiotic course even if symptoms improve, stay hydrated, and follow up if symptoms worsen or don't improve within a few days of treatment. Additionally, supportive care, such as analgesics for pain and antipyretics for fever, may be offered, and adjunctive therapy, such as intranasal saline irrigation or intranasal corticosteroids, has been shown to alleviate symptoms and potentially decrease antibiotic use 1. It is essential 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, as highlighted in the meta-analysis of adults with acute rhinosinusitis 1. Therefore, clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening) 1. In summary, the treatment approach for acute sinusitis should prioritize the use of amoxicillin-clavulanate, with doxycycline as an alternative for patients with penicillin allergy, and supportive care and adjunctive therapy should be offered to alleviate symptoms and potentially decrease antibiotic use. Some key points to consider when treating acute sinusitis include:

• Amoxicillin-clavulanate is the preferred agent for acute bacterial sinusitis due to its effectiveness, safety, and relatively narrow microbiologic spectrum 1.
• Doxycycline is an alternative for patients with penicillin allergy, as recommended by various professional societies 1.
• Nasal saline irrigation and over-the-counter decongestants like pseudoephedrine can help relieve symptoms, while pain relievers such as acetaminophen or ibuprofen can manage discomfort.
• Antibiotics are only recommended if symptoms persist beyond 10 days, are severe with high fever (>102°F), or worsen after initial improvement, as stated in the guidelines for acute respiratory tract infection in adults 1.
• Supportive care, such as analgesics for pain and antipyretics for fever, may be offered, and adjunctive therapy, such as intranasal saline irrigation or intranasal corticosteroids, has been shown to alleviate symptoms and potentially decrease antibiotic use 1.

From the FDA Drug Label

Levofloxacin is approved for the treatment of acute bacterial sinusitis (ABS) using either 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days Levofloxacin tablets are indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis

The treatment for acute sinusitis is levofloxacin 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days, for infections caused by Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis 2 2.

• Key points:
  • Dosage: 750 mg x 5 days or 500 mg x 10-14 days
  • Pathogens: Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
  • Drug: Levofloxacin

From the Research

Treatment Options for Acute Sinusitis

The treatment for acute sinusitis typically involves the use of antibiotics. According to 3, treatment guidelines recommend 10 to 14 days of therapy with amoxicillin/clavulanate, high-dose amoxicillin, cefpodoxime, cefuroxime, or a newer fluoroquinolone.

Antibiotic Regimens

• Amoxicillin/clavulanate is a commonly recommended treatment, with studies such as 3 and 4 suggesting its effectiveness in treating acute bacterial sinusitis.
• High-dose amoxicillin has also been studied, with mixed results. 5 found that high-dose amoxicillin/clavulanate was associated with more rapid improvement in symptoms, while 6 found no significant difference in efficacy between high-dose and standard-dose amoxicillin/clavulanate.
• Other antibiotics, such as cefuroxime, cefpodoxime, and cefdinir, may also be used as alternatives, as suggested by 4.

Duration of Therapy

The optimal duration of therapy is unknown, but some studies suggest treating until the patient becomes free of symptoms and then for an additional 7 days, as recommended by 4.

Safety and Efficacy

The safety and efficacy of different antibiotic regimens have been studied, with 3 finding that a short course (5 days) of gatifloxacin therapy was associated with comparable clinical cure rates and tolerability to those of standard 10-day therapy with gatifloxacin or amoxicillin/clavulanate. 7 found that amoxiclav (amoxicillin clavulanate) had a higher antibacterial efficacy and lower toxicity compared to ampicillin in the treatment of acute bacterial sinusitis.