From the Guidelines
For chronic sinusitis unresponsive to antibiotics with intermittent fever for 2 weeks, a course of systemic corticosteroids should be considered, as the condition may be a noninfectious form of sinusitis, such as chronic hyperplastic eosinophilic rhinosinusitis, which does not respond to antibiotics 1.
Key Considerations
- The patient's symptoms have persisted for an extended period, indicating a need for a thorough evaluation to rule out underlying conditions such as nasal polyps, septal deviation, or other structural abnormalities that may be contributing to the sinusitis 1.
- A coronal sinus CT with extra cuts through the ostiomeatal complex may be necessary to clarify the extent of disease and specific location or locations, guiding further treatment decisions 1.
- Nasal-sinus biopsy may be considered in suspected cases of neoplasia, fungal disease, granulomatous disease, or other conditions that may not respond to standard antibiotic therapy 1.
Treatment Approach
- Systemic corticosteroids may be prescribed to reduce inflammation and address potential underlying conditions such as chronic hyperplastic eosinophilic rhinosinusitis 1.
- Continued individualized medical therapy, including allergy management and nasal corticosteroids, may be beneficial in managing symptoms and preventing future exacerbations 1.
- Surgical intervention, such as functional endoscopic sinus surgery, may be considered if medical management fails to improve symptoms or if underlying structural abnormalities are identified 1.
Additional Recommendations
- Pain relievers like acetaminophen or ibuprofen can help manage discomfort and fever.
- Saline nasal irrigation with a neti pot or squeeze bottle twice daily can help clear mucus and bacteria.
- Consultation with an otolaryngologist or allergist-immunologist may be necessary to evaluate and manage underlying conditions contributing to the sinusitis 1.
From the FDA Drug Label
1.4 Acute Bacterial Sinusitis: 5 Day and 10 to 14 Day Treatment Regimens Levofloxacin is approved for the treatment of acute bacterial sinusitis (ABS) using either 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days
The treatment for chronic sinusitis that is unresponsive to antibiotics and characterized by intermittent fever for 2 weeks is not directly addressed in the provided drug labels. However, for acute bacterial sinusitis, levofloxacin is approved for treatment using either 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days 2.
- Key points:
- The provided drug labels do not directly address the treatment of chronic sinusitis.
- Levofloxacin is approved for the treatment of acute bacterial sinusitis.
- The dosage regimens for acute bacterial sinusitis are 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days. Given the information provided, no conclusion can be drawn for the treatment of chronic sinusitis that is unresponsive to antibiotics and characterized by intermittent fever for 2 weeks 22.