What is the dosage for medications to treat acute sinusitis?

Medication Dosages for Acute Sinusitis Treatment

For acute sinusitis, first-line treatment is amoxicillin-clavulanate 875mg/125mg twice daily for 10-14 days, with alternative options including doxycycline 100mg daily for 10 days for penicillin-allergic patients.

First-Line Antibiotic Treatment

Amoxicillin-Clavulanate

• For adults with acute sinusitis, the recommended dosage is 875mg/125mg twice daily for 10-14 days 1
• For more severe infections and respiratory tract infections, this higher dose is preferred over the 500mg/125mg three times daily regimen 1
• Treatment should continue until the patient has been symptom-free for approximately 7 days 2
• The 10-14 day course is standard to ensure complete eradication of bacterial infection 2

Special Populations

• For children with sinusitis, dosing is based on weight:
  • Children ≥12 weeks: 45mg/kg/day divided every 12 hours 1
  • Children weighing ≥40kg: follow adult dosing recommendations 1
• For patients with renal impairment (GFR <30 mL/min), the 875mg/125mg dose should not be used 1

Alternative Antibiotic Options

For Penicillin-Allergic Patients

• Doxycycline: 100mg once daily for 10 days 3
• For children ≥8 years: 4mg/kg/day in 2 divided doses (maximum 100mg per dose) 3
• Doxycycline should not be used in children under 8 years due to risk of dental staining 3

Other Alternatives

• Cephalosporins (if not anaphylactically sensitive to penicillin):
  • Cefuroxime: 500mg twice daily for 10-14 days 4, 2
  • Cefpodoxime or cefdinir for 10-14 days 4
• Respiratory fluoroquinolones (adults only): levofloxacin or moxifloxacin 4

Treatment Monitoring and Adjustment

• Evaluate patient response after 3-5 days of antibiotic therapy 2, 3
• If symptoms are improving, continue treatment to complete the 10-14 day course 2
• If no improvement is observed after 3-5 days, consider switching to a different antibiotic 2

Important Considerations

Antibiotics in Post-Viral Sinusitis

• Antibiotics are NOT recommended for post-viral acute rhinosinusitis in adults as they show no benefit and cause more adverse events 5
• Studies show no difference in cure rates or symptom duration between antibiotics and placebo for post-viral sinusitis 5

Nasal Corticosteroids

• Consider adding a nasal corticosteroid to reduce mucosal inflammation 4
• Studies show that mometasone furoate nasal spray 200μg twice daily for 15 days can significantly improve symptoms 5
• Nasal steroids may be more effective in patients with less severe symptoms at baseline 5

Common Pitfalls to Avoid

• Using azithromycin for initial therapy - it has relatively weak activity against common sinusitis pathogens 4
• Stopping antibiotics prematurely when symptoms improve can lead to incomplete eradication and potential relapse 2
• Using antibiotics for viral upper respiratory infections is inappropriate and strongly discouraged 3
• Not considering underlying factors like allergies in patients with recurrent sinusitis 4

Short-Course vs. Standard Therapy

• While traditional treatment is 10-14 days, some evidence suggests that shorter courses (5-7 days) may be effective for certain antibiotics 6
• However, the most recent guidelines from major societies still recommend the 10-14 day approach for most patients 2
• For uncomplicated acute maxillary sinusitis in adults, a 5-day course may be considered with certain antibiotics like cefuroxime-axetil 6