What medications are used to treat sinus infections?

Medications for Sinus Infections

Amoxicillin-clavulanate is the first-line antibiotic treatment for acute sinus infections, with alternatives including second/third generation cephalosporins or fluoroquinolones for those with penicillin allergies. 1, 2

Antibiotic Therapy

First-Line Treatment

• Amoxicillin-clavulanate is the preferred first-line antibiotic for acute bacterial sinusitis due to its coverage of common pathogens including resistant strains 1
• Standard duration of therapy is 7-10 days, though some newer antibiotics have shown effectiveness with 5-day courses 2, 3
• Appropriate criteria for antibiotic use include symptoms of sinusitis for 10-14 days or severe symptoms with fever, purulent nasal discharge, and facial pain 4

Alternative Antibiotics

• For patients with penicillin allergies, alternatives include:
  • Second/third generation cephalosporins (cefuroxime-axetil, cefpodoxime-proxetil) 1, 5
  • Fluoroquinolones (levofloxacin) for adults with confirmed acute bacterial sinusitis 6
  • Pristinamycin in cases of beta-lactam allergies 2

Treatment Failure

• If no improvement is seen within 3-5 days of starting antibiotics, an alternative antibiotic should be considered 4, 1
• For poor response to initial therapy, switch to an antibiotic with coverage against resistant bacteria, such as high-dose amoxicillin-clavulanate or fluoroquinolones 1

Adjunctive Therapies

Corticosteroids

• Intranasal corticosteroids are beneficial as an adjunct to antibiotic therapy in treating recurrent acute and chronic sinusitis 4, 1
• Short-term oral corticosteroids may be beneficial for severe cases or when rapid symptomatic improvement is needed 2, 7
• Nasal corticosteroids are particularly helpful when there is marked mucosal edema 1, 8

Supportive Measures

• Saline irrigation can help with symptom relief and is recommended as a first-line treatment alongside intranasal corticosteroids for chronic sinusitis 9
• Other supportive measures include adequate hydration, analgesics, warm facial packs, and sleeping with the head elevated 2
• Decongestants (topical and oral) may decrease nasal resistance and theoretically increase ostial patency, though prospective studies are lacking 4

Special Considerations

Chronic Sinusitis

• For chronic infectious sinusitis, a longer duration of antibiotic therapy might be required, with possible attention to anaerobic pathogens 4
• For chronic non-infectious (hyperplastic) sinusitis, systemic corticosteroids should be considered 4
• First-line treatment for chronic rhinosinusitis is nasal saline irrigation and intranasal corticosteroid sprays 9

When to Consider Surgical Management

• Medically resistant sinusitis may respond to appropriate nasal-sinus surgery 4
• Indications for immediate surgical management include development of neurological complications, such as meningeal syndrome or visual disturbances 2
• Functional endoscopic sinus surgery may result in significant improvement for localized persistent disease within the ostiomeatal complex 4

When to Refer to a Specialist

• Consultation with a specialist should be sought when:
  • There is a need to clarify the allergic or immunologic basis for sinusitis 4
  • Sinusitis is refractory to usual antibiotic treatment or recurrent 4, 1
  • Sinusitis is associated with unusual opportunistic infections 4
  • Concomitant conditions are present (chronic otitis media, asthma, nasal polyps) 4

Common Pitfalls

• Overdiagnosis of sinusitis and unnecessary treatment with antibiotics is a concern; appropriate diagnostic criteria should be followed 4
• Failure to switch antibiotics when there is no improvement after 3-5 days of initial therapy 4, 1
• Not considering underlying factors in recurrent sinusitis such as allergies, immunodeficiency, or anatomic abnormalities 1
• Inadequate duration of therapy or premature discontinuation of antibiotics can lead to treatment failure 3