From the Guidelines
For chronic sinusitis that is refractory to antibiotic therapy, a combination of nasal corticosteroids, saline nasal irrigation, and over-the-counter pain relievers should be considered, with potential referral to an ENT specialist for further evaluation and treatment, including extended corticosteroid treatment, immunotherapy, or surgical intervention. The treatment of chronic sinusitis is often less clear-cut, with the role of bacterial infection and antibiotic therapy being controversial 1. However, it is essential to target inflammation directly, as many cases of sinusitis are viral or inflammatory rather than bacterial.
The use of nasal corticosteroids, such as fluticasone or mometasone, can help decrease inflammation, while saline nasal irrigation can aid in clearing out mucus and debris. Over-the-counter pain relievers like acetaminophen or ibuprofen can be used as needed for pain and inflammation. Decongestants like pseudoephedrine may provide temporary relief but should not be used for more than 3-5 days to avoid rebound congestion.
If symptoms persist beyond 12 weeks, it is crucial to evaluate for underlying causes, such as nasal polyps, allergies, or structural issues, and consider referral to an ENT specialist 1. In some cases, surgical intervention, including functional endoscopic sinus surgery, may be necessary to improve sinus drainage and alleviate symptoms. The goal of treatment should be to maximize medical therapy for underlying rhinitis before proceeding with surgical intervention, and to individualize treatment for each patient, including allergy management and continued medical therapy after surgery 1.
From the FDA Drug Label
To evaluate the safety and efficacy of a high dose short course of levofloxacin, 780 outpatient adults with clinically and radiologically determined acute bacterial sinusitis were evaluated in a double-blind, randomized, prospective, multicenter study comparing levofloxacin 750 mg by mouth once daily for five days to levofloxacin 500 mg by mouth once daily for 10 days Clinical success rates (defined as complete or partial resolution of the pre-treatment signs and symptoms of ABS to such an extent that no further antibiotic treatment was deemed necessary) in the microbiologically evaluable population were 91.4% (139/152) in the levofloxacin 750 mg group and 88.6% (132/149) in the levofloxacin 500 mg group at the test-of-cure (TOC) visit (95% CI [-4. 2,10] for levofloxacin 750 mg minus levofloxacin 500 mg).
The treatment options for acute bacterial sinusitis include levofloxacin 750 mg by mouth once daily for 5 days or 500 mg by mouth once daily for 10 to 14 days. However, the FDA drug label does not provide information on the treatment options for chronic sinusitis that is refractory to antibiotic therapy. Therefore, based on the provided information, no conclusion can be drawn for the treatment of chronic sinusitis that is refractory to antibiotic therapy 2.