What antibiotic is recommended for 14 days for sinusitis?

Recommended Antibiotics for 14-Day Treatment of Sinusitis

Amoxicillin is the recommended first-line antibiotic for a 14-day course in the treatment of sinusitis, with high-dose amoxicillin-clavulanate as the preferred alternative for patients who do not respond to initial therapy. 1

First-Line Treatment Options

• Amoxicillin is the drug of choice for both children and adults with sinusitis due to its effectiveness, low cost, and good tolerability profile. The standard course for acute sinusitis is 10 to 14 days. 1
• For patients allergic to or intolerant of amoxicillin, alternatives include cephalosporins (such as cefuroxime), macrolides, or quinolones. 1
• Trimethoprim-sulfamethoxazole can be used as an alternative drug in adults, though resistance is more commonly seen in children. 1

Treatment Duration and Response Assessment

• Acute sinusitis generally responds to treatment within 10 to 14 days. Some physicians continue treatment until the patient's symptoms improve to near normal. 1
• A reasonable approach is to evaluate the patient after 3-5 days of treatment. If symptoms are improving, continue the antibiotic for a total of 10-14 days. 1
• If there is no improvement after 3-5 days of initial therapy, switching to a different antibiotic is recommended. 1

Second-Line Treatment Options

• For patients who do not respond to amoxicillin or have a poor response to initial therapy, high-dose amoxicillin-clavulanate (90 mg/kg amoxicillin and 6.4 mg/kg clavulanate, not to exceed 2 g every 12 hours) is recommended. 1
• Other appropriate choices for second-line therapy include cefuroxime, cefpodoxime, cefprozil, and cefdinir. 1
• Fluoroquinolones like levofloxacin (500 mg once daily for 10-14 days) may be considered, particularly in adults with moderate disease or beta-lactam allergies. 2, 3

Special Considerations

• For patients with partial response to initial therapy, continuing antibiotic treatment for another 10 to 14 days or switching to second-line options is recommended. 1
• In regions with high antibiotic resistance or for sinusitis that fails to improve after 21-28 days of initial treatment, broader-spectrum agents should be considered. 1
• For protracted or severe cases where anaerobic pathogens are suspected, clindamycin or metronidazole might be considered in combination with a broad-spectrum antibiotic. 1

Common Pitfalls and Caveats

• Overdiagnosis of sinusitis and unnecessary antibiotic use is a concern. Appropriate criteria for antibiotic use include symptoms lasting 10-14 days or severe symptoms with fever, purulent nasal discharge, and facial pain. 1
• Patients should complete the full course of antibiotics (14 days) even if symptoms improve earlier, to ensure complete eradication of the organism and prevent relapse. 1
• Recent evidence suggests that antibiotics may not be beneficial for post-viral acute rhinosinusitis, as it is often self-limiting. However, for confirmed bacterial sinusitis, a full course of appropriate antibiotics is still recommended. 1

Adjunctive Treatments

• Comfort measures such as adequate rest, hydration, analgesics, warm facial packs, and sleeping with the head elevated may help manage symptoms. 1
• Nasal corticosteroids might be helpful in patients with acute and chronic sinusitis, particularly when there is marked mucosal edema. 1
• Topical and oral decongestants may decrease nasal resistance and theoretically increase ostial patency, though prospective studies are lacking. 1