From the Guidelines
A 10-day course of amoxicillin or doxycycline is not typically prescribed as the initial treatment for acute sinusitis, as most cases are self-limited and resolve without antibiotics. According to the American College of Physicians and the Centers for Disease Control and Prevention, watchful waiting without antibiotic therapy is recommended as the initial management for all patients with uncomplicated acute bacterial rhinosinusitis (ABRS), regardless of severity 1. The use of antibiotics, such as amoxicillin or doxycycline, is only recommended for patients with persistent symptoms for more than 10 days without clinical improvement, severe symptoms, or worsening symptoms after an initial period of improvement 1.
Some key points to consider when treating acute sinusitis include:
- The majority of cases are caused by viral pathogens, and antibiotics are not effective against viral infections 1
- The use of antibiotics can lead to adverse effects, and the number needed to harm is 8, compared to a number needed to treat of 18 1
- Adjunctive therapy, such as intranasal saline irrigation or intranasal corticosteroids, can alleviate symptoms and potentially decrease antibiotic use 1
- Patients who are seriously ill, deteriorate clinically despite antibiotic therapy, or have recurrent episodes should be referred to a specialist 1
In terms of specific treatment options, amoxicillin-clavulanate is the preferred agent, and doxycycline or a respiratory fluoroquinolone may be used as an alternative in patients with ABRS 1. However, the use of these antibiotics should be reserved for patients who meet specific clinical criteria, and patients should be closely monitored for adverse effects and treatment failure.