What is the treatment for sinusitis?

From the Guidelines

Sinusitis treatment should prioritize symptom management and addressing the underlying cause, with a focus on nasal saline irrigation, over-the-counter pain relievers, and intranasal corticosteroids for acute cases, and longer courses of intranasal steroids, saline irrigation, and possibly oral steroids or longer antibiotic courses for chronic cases. For acute sinusitis, treatment typically involves a combination of symptom management and addressing the underlying cause. This can include:

• Nasal saline irrigation (using a neti pot or squeeze bottle) 1-2 times daily
• Over-the-counter pain relievers like acetaminophen (325-650mg every 4-6 hours) or ibuprofen (400-600mg every 6-8 hours)
• Nasal decongestant sprays like oxymetazoline can provide temporary relief but shouldn't be used for more than 3 days to avoid rebound congestion
• Intranasal corticosteroids such as fluticasone (1-2 sprays per nostril daily) or mometasone can reduce inflammation 1. Most cases of acute sinusitis are viral and resolve within 7-10 days without antibiotics. However, if symptoms persist beyond 10 days, worsen after initial improvement, or include high fever and severe facial pain, bacterial sinusitis may be present. In these cases, antibiotics like amoxicillin-clavulanate (875/125mg twice daily for 5-7 days) may be prescribed 1. For chronic sinusitis, longer courses of intranasal steroids, saline irrigation, and possibly oral steroids or longer antibiotic courses may be needed. Addressing underlying factors like allergies or structural issues is essential for preventing recurrence. Stay hydrated and rest to support your body's natural healing process. It's worth noting that the use of antibiotics should be judicious, as overuse can lead to resistance, and the choice of antibiotic should be guided by the suspected or confirmed causative organism, as well as local resistance patterns 1. In terms of specific antibiotic regimens, a 10- to 14-day course of antibiotic might be adequate for most patients with acute disease, but some experts suggest that patients should be treated until they are free of symptoms plus 7 days 1. Ultimately, the goal of treatment is to alleviate symptoms, prevent complications, and improve quality of life, while minimizing the risk of adverse effects and promoting prudent use of antibiotics.

From the FDA Drug Label

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 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)

Treatment of Acute Bacterial Sinusitis:

• 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.
• Clinical success rates were 91.4% for the 750 mg group and 88.6% for the 500 mg group at the test-of-cure visit 2.
• The 95% CI for the difference of response rates was [-4.2,10] for levofloxacin 750 mg minus levofloxacin 500 mg 2.

From the Research

Sinusitis Treatment Overview

• Acute bacterial sinusitis (ABS) is a common problem in both children and adults, with three clinical presentations: onset with persistent symptoms, onset with severe symptoms, and onset with worsening symptoms 3.
• The diagnosis of acute sinusitis can be confirmed with images, and the predominant bacterial species implicated are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in children 3.

Antibiotic Treatment

• Therapy for ABS may be initiated with high-dose amoxicillin or amoxicillin-clavulanate, with alternatives including cefuroxime, cefpodoxime, or cefdinir 3.
• For penicillin-allergic patients or those unresponsive to amoxicillin, amoxicillin-clavulanate or clarithromycin/azithromycin may be prescribed 3.
• Studies have compared the effectiveness of different antibiotic regimens, including high-dose vs standard-dose amoxicillin plus clavulanate 4, 5.
• Amoxicillin is as effective as amoxicillin-clavulanate as a first-line treatment for acute bacterial rhinosinusitis for those without a beta-lactam allergy 6.

Comparison of Antibiotic Regimens

• A randomized clinical trial found that adults treated for clinically diagnosed acute sinusitis did not appear to benefit from taking high-dose compared with standard-dose amoxicillin plus clavulanate 4.
• Another study found that adults with clinically diagnosed acute bacterial sinusitis were more likely to improve rapidly when treated with IR HD than with SD, but not when treated with ER HD 5.
• Levofloxacin has been shown to be as effective and better tolerated than amoxicillin-clavulanate for treating acute sinusitis in adult outpatients 7.

Supportive Care and Complications

• Supportive care for rhinosinusitis, including use of saline irrigation, nasal steroids or antihistamines, and decongestants, may help reduce the severity of symptoms 6.
• Complications of rhinosinusitis are rare but may include orbital cellulitis, meningitis, and abscess, and computed tomography and referral to an otolaryngologist should be considered for patients with recurrent rhinosinusitis or concern about complications 6.