From the Guidelines
Antibiotic treatment for acute sinusitis should be initiated with amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days. This recommendation is based on the latest clinical practice guideline for adult sinusitis, which suggests that amoxicillin with or without clavulanate is the preferred choice for treating acute bacterial rhinosinusitis (ABRS) 1. The guideline recommends this treatment due to its preponderance of benefit over harm, as determined by randomized controlled trials (RCTs) with heterogeneity and noninferiority design.
When considering treatment, it's essential to note that most cases of acute sinusitis are viral in nature and will resolve without antibiotic therapy within 7-10 days. Therefore, antibiotic treatment should be reserved for patients with severe symptoms, symptoms lasting more than 10 days without improvement, or worsening symptoms after initial improvement.
Key points to consider when treating acute sinusitis include:
- First-line treatment: amoxicillin with or without clavulanate for 5 to 10 days
- Alternatives for penicillin-allergic patients may be considered, but amoxicillin with or without clavulanate remains the first-line choice 1
- Supportive measures like saline nasal irrigation, intranasal corticosteroids, and analgesics should accompany antibiotic therapy to help alleviate symptoms
- Watchful waiting is appropriate for mild cases, as overuse of antibiotics contributes to bacterial resistance and potential side effects.
From the FDA Drug Label
1.4 Acute Bacterial Sinusitis: 5 Day and 10 to 14 Day Treatment Regimens Levofloxacin tablets are indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis
1.6 Acute Bacterial Sinusitis Moxifloxacin hydrochloride tablets are indicated in adult patients (18 years of age and older) for the treatment of acute bacterial sinusitis (ABS) caused by susceptible isolates of Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis
The recommended antibiotic treatment for acute sinusitis is levofloxacin or moxifloxacin.
- Levofloxacin can be administered as 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days.
- Moxifloxacin is also an option for the treatment of acute bacterial sinusitis. Both options are effective against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 2, 3.
From the Research
Recommended Antibiotic Treatment for Acute Sinusitis
The recommended antibiotic treatment for acute sinusitis includes:
- Amoxicillin/clavulanate for 10 to 14 days 4
- High-dose amoxicillin 4
- Cefpodoxime 4
- Cefuroxime 4
- Newer fluoroquinolones such as gatifloxacin, moxifloxacin, and levofloxacin 4, 5, 6
Comparison of Antibiotic Treatments
Studies have compared the effectiveness of different antibiotic treatments for acute sinusitis:
- Gatifloxacin (5-day or 10-day course) was compared to amoxicillin/clavulanate (10-day course) and found to have comparable clinical cure rates and tolerability 4
- High-dose amoxicillin/clavulanate was compared to standard-dose amoxicillin/clavulanate and found to have no significant difference in efficacy 7
- Moxifloxacin was compared to amoxicillin/clavulanate and found to be statistically equivalent in terms of clinical resolution 5
- Levofloxacin was compared to amoxicillin-clavulanate and found to be as effective and better tolerated 6
Duration of Antibiotic Treatment
The duration of antibiotic treatment for acute sinusitis varies: