What is the recommended treatment for a sinus or ear infection?

Treatment of Sinus and Ear Infections

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

Diagnosis Criteria for Acute Bacterial Sinusitis

Antibiotics should be initiated when one of the following is present:

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

Treatment Algorithm for Sinus Infections

First-Line Treatment

• Amoxicillin-clavulanate: 875/125 mg twice daily for 5-7 days 1
• High-dose amoxicillin-clavulanate: Consider for high-risk patients (2000 mg amoxicillin component with 125 mg clavulanate twice daily) 1

Alternative Options (Penicillin Allergy)

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

Azithromycin Option

• Azithromycin: 500 mg daily for 3 days 2
• Note: While convenient due to shorter course, this should be reserved for patients with penicillin allergy as resistance patterns may affect efficacy

Treatment for Acute Otitis Media (Ear Infections)

Adults

• Amoxicillin-clavulanate: 875/125 mg twice daily for 5-7 days 1

Children

• Azithromycin: 30 mg/kg as a single dose OR 10 mg/kg once daily for 3 days OR 10 mg/kg on day 1 followed by 5 mg/kg/day on days 2-5 2
• Amoxicillin-clavulanate: Weight-based dosing for 5-7 days 1

Adjunctive Treatments

These treatments help manage symptoms and improve outcomes:

• Intranasal corticosteroids: Reduce inflammation and improve drainage 3, 1
• Saline nasal irrigation: Helps clear mucus and reduce congestion 1
• Analgesics: Acetaminophen or ibuprofen for pain and fever 1
• Adequate hydration: Maintains proper mucus consistency 1

When to Consider Referral

• Symptoms persist despite appropriate antibiotic therapy
• Signs of complications (orbital involvement, severe pain, persistent fever)
• Symptoms lasting beyond 3 weeks despite treatment 1

Follow-Up Recommendations

• Assess for clinical improvement within 72 hours of starting antibiotics
• Consider switching to a broader-spectrum antibiotic if no improvement is seen
• Complete the full course of antibiotics even if symptoms improve 1

Important Considerations

• Watchful waiting is appropriate for uncomplicated cases with mild symptoms 1
• While decongestants are commonly used, there are limited data supporting their efficacy in sinusitis 3
• For chronic sinusitis (>12 weeks), a longer course of antibiotics (minimum 3 weeks) plus intranasal corticosteroids may be needed 3
• Bacterial sinusitis is often preceded by viral rhinosinusitis ("common cold"), and antibiotics should be withheld for approximately one week in these cases 3

Remember that proper diagnosis is crucial before initiating antibiotics, as most upper respiratory infections are viral in nature and do not require antibiotic treatment.