What is the treatment for a sinus infection?

Treatment for Sinus Infection

For acute bacterial sinusitis, amoxicillin-clavulanate is the preferred first-line antibiotic treatment due to increasing prevalence of beta-lactamase-producing organisms. 1

Diagnosis of Bacterial Sinusitis

• Acute bacterial sinusitis should be differentiated from viral upper respiratory infections, as antibiotics are only indicated for bacterial infections 1
• Diagnosis is based on:
  • Symptoms persisting for 10-14 days without improvement 2, 3
  • Severe symptoms including fever with purulent nasal discharge 2
  • Unilateral or bilateral infraorbital pain that increases when bending forward 1
  • Purulent rhinorrhea 1

Antibiotic Treatment

First-Line Treatment

• Amoxicillin-clavulanate is the preferred first-line treatment 1, 3
• Standard duration is 7-10 days, though some cephalosporins have shown effectiveness in 5-day courses 1, 3

Alternative Antibiotics

• For penicillin allergies: second/third generation cephalosporins (cefuroxime-axetil or cefpodoxime-proxetil) 1, 3
• For severe penicillin allergies: pristinamycin or clarithromycin/azithromycin 4, 5

Treatment Monitoring

• If no improvement is seen within 3-5 days, reevaluation and change in antibiotic is necessary 2, 3
• For treatment failure, switch to an antibiotic that covers resistant bacteria (high-dose amoxicillin-clavulanate or fluoroquinolones) 3

Adjunctive Therapies

• Decongestants can be used short-term (no more than 3 days for topical forms) to reduce nasal congestion and facilitate drainage 1, 6
• Intranasal corticosteroids are beneficial as adjuncts to antibiotics, particularly when there is marked mucosal edema 2, 3
• Saline irrigation helps with mucociliary clearance 7
• Adequate hydration, analgesics, and sleeping with head elevated provide symptomatic relief 4

Special Considerations

By Sinus Location

• Maxillary sinusitis of dental origin definitely requires antibiotic therapy 1
• Frontal, ethmoidal, or sphenoidal sinusitis carry higher risk of complications and mandate antibiotic therapy 1, 4
• Sphenoid sinusitis presents with characteristic retro-orbital headache radiating to the vertex and requires aggressive treatment 4

Pediatric Considerations

• Amoxicillin-clavulanate remains first-line treatment for children 1
• OTC cough and cold medications should be avoided in children under 6 years due to potential toxicity 1

Chronic Sinusitis

• Defined as symptoms lasting at least 12 consecutive weeks 7
• First-line treatment includes nasal saline irrigation and intranasal corticosteroid sprays 7
• Antibiotics may be considered if there is evidence of an active, superimposed acute infection 7
• Referral to an otolaryngologist is indicated if medical management fails 7

Warning Signs Requiring Immediate Attention

• Development of neurological complications (meningeal syndrome) 4
• Visual disturbances 4
• Facial swelling 3
• Symptoms that worsen after initial improvement 5

Underlying Factors to Consider

• Allergic rhinitis may contribute to sinusitis and should be treated concurrently 2, 8
• Gastroesophageal reflux disease (GERD) has been suggested as a cause of sinusitis 2
• Immunodeficiency should be considered in cases of recurrent sinusitis 2, 3

Remember that completing the full course of antibiotics is essential to prevent relapse, even if symptoms improve before completion 3.