What is the treatment for a sinus infection?

Treatment for Sinus Infection

Antibiotic therapy is indicated when the diagnosis of acute bacterial sinusitis is established, with amoxicillin-clavulanate as the preferred first-line 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 primarily based on clinical presentation with symptoms lasting more than 7-10 days or worsening after 5-7 days 2
• Key diagnostic indicators include unilateral or bilateral infraorbital pain that increases when bending forward and purulent rhinorrhea 1, 2

First-Line Antibiotic Treatment

• Amoxicillin-clavulanate is the preferred first-line treatment due to increasing prevalence of beta-lactamase-producing organisms 1, 3
• For maxillary sinusitis (most common type), recommended antibiotics include amoxicillin-clavulanate, second and third generation cephalosporins (except cefixime) such as cefuroxime-axetil, cefpodoxime-proxetil, or cefotiam-hexetil 2, 4
• Standard duration of treatment is 7-10 days, though some cephalosporins have shown effectiveness in 5-day courses 1, 4

Alternative Treatment Options

• For patients with penicillin allergies, alternatives include second/third generation cephalosporins (cefuroxime, cefpodoxime, cefprozil, cefdinir) or pristinamycin 1, 4, 3
• For more severe infections or treatment failures, fluoroquinolones active against pneumococci (levofloxacin, moxifloxacin) may be considered, particularly for frontal, ethmoidal, or sphenoidal sinusitis 2, 5

Treatment Based on Sinusitis Type

• Maxillary sinusitis (most common): Amoxicillin-clavulanate or second/third generation cephalosporins 2, 4
• Frontal, ethmoidal, or sphenoidal sinusitis (higher risk of complications): Amoxicillin-clavulanate, second/third generation cephalosporins, or fluoroquinolones active against pneumococci 2, 6
• Maxillary sinusitis of dental origin: Antibiotic therapy is definitely indicated 2, 1

Adjunctive Therapies

• Intranasal corticosteroids are recommended as an adjunct to antibiotic therapy 4
• Decongestants can be used short-term to reduce nasal congestion and facilitate drainage (use topical decongestants for no more than 3 days) 1
• Supportive measures include adequate hydration, analgesics, warm facial packs, and sleeping with the head elevated 4

Treatment Failure Protocol

• If no improvement after 3-5 days of treatment, reevaluation is necessary 1, 4
• For poor response to initial therapy, switch to an antibiotic that covers resistant bacteria, such as high-dose amoxicillin-clavulanate or fluoroquinolones 1, 4

Special Considerations

• Clinical signs suggestive of complicated sinusitis (meningeal syndrome, exophthalmos, palpebral edema, ocular mobility disorders, severe pain) require hospitalization, bacteriological testing, and parenteral antibiotic therapy 2, 6
• For patients with recurrent sinusitis (≥3 episodes per year), evaluation for underlying inflammation, allergy, immunodeficiency, and anatomic abnormalities is recommended 4

Common Pitfalls to Avoid

• Treating viral upper respiratory infections with antibiotics - wait until symptoms persist beyond 7-10 days or worsen after 5-7 days 2, 7
• Using fluoroquinolones as first-line therapy - reserve these for treatment failures or specific sinusitis types 2, 5
• Inadequate duration of therapy - continue antibiotics until the patient is symptom-free for 7 days 4, 8
• Failure to consider resistant pathogens in treatment failures - beta-lactamase-producing bacteria are increasingly common 3