From the Guidelines
Antibiotics should be prescribed for acute bacterial sinusitis when symptoms are severe, persist beyond 10 days without improvement, or worsen after initial improvement, with first-line treatment being amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 5-7 days, or amoxicillin 500 mg three times daily for patients with mild cases, as recommended by the most recent and highest quality study 1.
Key Considerations
- The American College of Physicians and the Centers for Disease Control and Prevention recommend reserving antibiotic treatment for patients with persistent symptoms for more than 10 days, or those with severe symptoms, such as high fever, facial pain, or purulent nasal discharge 1.
- For penicillin-allergic patients, doxycycline 100 mg twice daily or a respiratory fluoroquinolone like levofloxacin 750 mg daily can be used as alternative treatments 1.
- Supportive measures, including saline nasal irrigation, intranasal corticosteroids like fluticasone (1-2 sprays per nostril daily), and analgesics for pain relief, can help alleviate symptoms and potentially decrease antibiotic use 1.
Treatment Options
- Amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 5-7 days
- Amoxicillin 500 mg three times daily for patients with mild cases
- Doxycycline 100 mg twice daily for penicillin-allergic patients
- Respiratory fluoroquinolone like levofloxacin 750 mg daily for penicillin-allergic patients
Important Notes
- Patients should complete the full course of antibiotics even if symptoms improve 1.
- Patients should seek medical attention if symptoms worsen despite treatment, high fever develops, or if they experience severe headache, visual changes, or mental status changes, as these may indicate complications requiring immediate care 1.
From the FDA Drug Label
- 4 Acute Bacterial Sinusitis: 5 Day and 10 to 14 Day Treatment Regimens Levofloxacin tablets are indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis [see Clinical Studies (14.4)]. 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).
Levofloxacin is indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.
- The recommended treatment regimens are 750 mg by mouth once daily for 5 days or 500 mg by mouth once daily for 10 to 14 days.
- Clinical success rates were 91.4% in the levofloxacin 750 mg group and 88.6% in the levofloxacin 500 mg group at the test-of-cure visit 2.
From the Research
Sinusitis Antibiotic Treatment Options
- Various antibiotics have been studied for the treatment of acute sinusitis, including levofloxacin, amoxicillin-clavulanate, azithromycin, cefdinir, and amoxicillin/potassium clavulanate 3, 4, 5, 6, 7
- These studies have compared the effectiveness and safety of different antibiotic regimens, including dosage and duration of treatment
Comparison of Antibiotic Regimens
- A study comparing levofloxacin and amoxicillin-clavulanate found that levofloxacin was as effective and better tolerated than amoxicillin-clavulanate for treating acute sinusitis in adult outpatients 3
- Another study comparing azithromycin and amoxicillin-clavulanate found that azithromycin was equivalent in efficacy and better tolerated than amoxicillin-clavulanate for treating acute bacterial sinusitis 4
- A study comparing cefdinir and amoxicillin-clavulanate found that cefdinir was as effective clinically as amoxicillin-clavulanate for treating acute community-acquired bacterial sinusitis 5
Specific Antibiotic Regimens
- Azithromycin extended release has been shown to be effective in resolving symptoms of acute sinusitis, with a single 2-g dose resulting in symptom resolution at 5 days in 29.7% of patients 6
- Amoxicillin/potassium clavulanate has been shown to be effective in treating acute bacterial sinusitis in children, with a high-dose regimen resulting in significantly more cures and fewer failures than placebo 7
Adverse Events and Tolerability
- The most common adverse events associated with antibiotic treatment for sinusitis include nausea, diarrhea, vaginitis, and abdominal pain 3, 4, 5
- Azithromycin and cefdinir have been shown to be better tolerated than amoxicillin-clavulanate, with fewer treatment-related adverse events and discontinuations 4, 5