From the Guidelines
The treatment for sinusitis typically involves antibiotics, intranasal corticosteroids, and decongestants to decrease inflammation and alleviate symptoms 1.
Treatment Options
- Antibiotics: The primary form of medical treatment for acute bacterial sinusitis, with the most common bacteria being S pneumoniae, M catarrhalis, and H influenzae 1.
- Intranasal corticosteroids: Helpful in treating recurrent acute and chronic sinusitis, and may be used as an adjunct to antibiotic therapy 1.
- Decongestants: Such as oxymetazoline hydrochloride, may be used to relieve nasal congestion, although their efficacy in sinusitis is not well established 1.
Antibiotic Selection
- Amoxicillin: A common first-line treatment for acute sinusitis, with a dose of 90 mg/kg/d in 2 divided doses (maximum dose of 1.0 g every 12 hours) to overcome penicillin resistance 1.
- Cephalosporins: Such as cefuroxime axetil and cefprozil, may be used as alternative treatments, with twice-daily administration and enhanced activity against b-lactamase–producing H influenzae, M catarrhalis, and S aureus 1.
Treatment Duration
- Acute sinusitis: Antibiotic treatment for 10-14 days is generally prescribed, with a favorable rate of clinical response of 70%-80% 1.
- Chronic sinusitis: A longer duration of therapy may be required, with possible attention to anaerobic pathogens, and consideration of systemic corticosteroids or surgical intervention 1.
From the Research
Treatment Options for Sinusitis
The treatment for sinusitis typically involves antibiotics, with the goal of targeting the underlying bacterial infection. The choice of antibiotic depends on various factors, including the severity of symptoms, patient allergies, and the likelihood of antibiotic resistance 2, 3, 4, 5, 6.
Antibiotic Therapy
- Amoxicillin or amoxicillin-clavulanate are commonly recommended as first-line treatments for acute bacterial sinusitis 2, 5.
- In cases of penicillin allergy, alternatives such as cefuroxime, cefpodoxime, or cefdinir may be prescribed 2.
- For patients with severe drug allergies, clarithromycin or azithromycin may be considered 2.
- The optimal duration of antibiotic therapy is unknown, but treatment courses typically range from 7 to 14 days 2, 3, 5.
Duration of Treatment
- Some studies suggest that short-course antibiotic therapy (less than or equal to 5 days) may be effective for uncomplicated acute maxillary sinusitis in adults 3.
- However, other guidelines recommend a 10- to 14-day treatment course for acute sinusitis 3, 5.
Adjunctive Treatments
- Symptomatic treatment, such as pain medication and decongestants, may be sufficient for patients with mild symptoms 6.
- The use of adjunctive treatments, such as fluticasone propionate, may be beneficial in selected cases, such as patients with recurrent sinusitis 6.
Diagnosis and Treatment Considerations
- The clinical diagnosis of acute bacterial sinusitis can be challenging, and primary care doctors should be cautious in diagnosing and treating sinusitis 6.
- Sinus imaging studies are not recommended for routine diagnosis but may be helpful in selected cases 6.
- Treatment should take into account current recommendations for treating infections caused by Streptococcus pneumoniae and Haemophilus influenzae, which are common causes of acute sinusitis 2, 3, 4, 5, 6.