Do we treat acute exacerbation of chronic sinusitis?

From the Guidelines

Yes, acute exacerbation of chronic sinusitis should be treated with a comprehensive approach that includes antibiotics, intranasal corticosteroids, and adjunctive therapies to address both the acute bacterial infection and underlying chronic inflammation. The recommended approach typically involves antibiotics such as amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days for mild cases, or 10-14 days for more severe cases, as suggested by 1. Alternatives include doxycycline 100 mg twice daily, levofloxacin 500 mg daily, or moxifloxacin 400 mg daily for patients with penicillin allergies.

Key Components of Treatment

• Intranasal corticosteroids like fluticasone 1-2 sprays per nostril daily or mometasone 2 sprays per nostril daily should be used concurrently to reduce inflammation, as noted in 1.
• Saline nasal irrigation with devices like NeilMed twice daily helps clear mucus and debris.
• For symptomatic relief, oral decongestants such as pseudoephedrine 30-60 mg every 4-6 hours (maximum 240 mg daily) can be used short-term, along with analgesics like acetaminophen or NSAIDs as needed for pain.

Considerations for Referral and Surgical Intervention

If symptoms persist beyond 2-3 weeks of appropriate therapy, referral to an ENT specialist is warranted to consider imaging studies or potential surgical intervention, especially if there are anatomical factors contributing to recurrent infections, as discussed in 1. Surgical approaches, including endoscopic and open procedures, may be necessary for chronic infectious sinusitis, particularly when there is evidence of mechanical blockage of the ostiomeatal complex.

From the FDA Drug Label

Levofloxacin tablets are indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis [see Clinical Studies (14.4)]. There is no mention of acute exacerbation of chronic sinusitis in the provided drug label. The FDA drug label does not answer the question.

From the Research

Treatment of Acute Exacerbation of Chronic Sinusitis

• The treatment of acute exacerbation of chronic sinusitis involves the use of various medications, including antibiotics, corticosteroids, and decongestants 2, 3, 4, 5.
• A study published in 2011 found that systemic corticosteroids are effective in relieving symptoms of acute sinusitis, with a significant reduction in symptoms at days 3-7 and 4-10 or 12 2.
• Another study published in 1999 compared the effectiveness of levofloxacin and amoxicillin-clavulanate for the treatment of acute sinusitis in adults, and found that both treatments were effective, but levofloxacin was better tolerated 3.
• A systematic review published in 2008 found that antibiotics, antihistamines, decongestants, and topical corticosteroids are effective in the treatment of acute sinusitis, but the quality of evidence varies 4.
• A study published in 2000 found that the addition of mometasone furoate nasal spray to oral antibiotics significantly reduces symptoms of acute sinusitis compared to antibiotic treatment alone 5.
• The use of acetylcysteine, a mucolytic and antioxidant agent, has been studied in the treatment of subacute sinusitis, but a study published in 2017 found that it had no benefit in the treatment of subacute sinusitis 6.

Medications Used

• Antibiotics, such as amoxicillin-clavulanate and levofloxacin, are commonly used to treat acute sinusitis 2, 3, 4.
• Systemic corticosteroids, such as prednisone and betamethasone, are used to reduce inflammation and relieve symptoms 2.
• Decongestants, such as pseudoephedrine, are used to relieve nasal congestion 4.
• Topical corticosteroids, such as mometasone furoate nasal spray, are used to reduce inflammation and relieve symptoms 5.

Treatment Outcomes

• The treatment outcomes for acute exacerbation of chronic sinusitis vary depending on the medication used and the individual patient's response to treatment 2, 3, 4, 5.
• A significant reduction in symptoms is often seen with the use of systemic corticosteroids and antibiotics 2.
• The addition of topical corticosteroids to oral antibiotics can significantly reduce symptoms of acute sinusitis 5.