What treatment is recommended for sinusitis with symptoms of sinus pressure, sinus pain, dark mucus, hyperthermia, and tachycardia?

Acute Bacterial Sinusitis with Systemic Symptoms

Start amoxicillin 875 mg twice daily for 10-14 days immediately, combined with intranasal corticosteroids, analgesics for fever control, and supportive measures including hydration and warm facial compresses. 1, 2

Immediate Assessment and Red Flags

Your presentation with high fever (102°F), tachycardia (130 bpm), dark mucus, sinus pain and pressure indicates acute bacterial sinusitis requiring prompt antibiotic therapy. 1 The combination of fever and tachycardia warrants close monitoring, as these systemic symptoms suggest significant bacterial infection rather than viral rhinosinusitis. 1

Critical warning signs to monitor: Severe headache, visual changes, periorbital edema, altered mental status, or neck stiffness would indicate potential orbital or intracranial complications requiring emergency evaluation. 3 These complications, while rare, can be life-threatening and demand immediate specialist referral. 3

Primary Antibiotic Treatment

First-line therapy is amoxicillin 875 mg twice daily for 10-14 days. 1, 2 This remains the gold standard due to proven efficacy, low cost, and tolerability. 1 Given your fever and systemic symptoms, the higher dose (875 mg) is more appropriate than standard dosing. 2

If you have taken antibiotics in the past 30 days or live in an area with high antibiotic resistance, start with high-dose amoxicillin-clavulanate (875 mg/125 mg twice daily) instead. 2 This provides coverage against β-lactamase-producing organisms like Haemophilus influenzae and Moraxella catarrhalis. 2

For documented penicillin allergy: Use cefuroxime, cefpodoxime, or cefdinir as alternatives. 1, 2 The cross-reactivity risk with second- and third-generation cephalosporins is negligible. 2 Avoid azithromycin due to 20-25% resistance rates. 2

Adjunctive Therapies (Start These Immediately)

Intranasal corticosteroids should be started alongside antibiotics to reduce mucosal inflammation and promote sinus drainage. 1, 2 These improve symptom resolution and may decrease the need for prolonged antibiotic use. 2

Fever and pain management: Use acetaminophen or NSAIDs to control your 102°F fever and facial pain. 1 Your tachycardia (130 bpm) is likely secondary to fever and should improve as temperature normalizes. 1

Supportive measures: 1

• Adequate hydration (at least 8 glasses of water daily)
• Warm facial compresses applied 3-4 times daily
• Steamy showers to promote drainage
• Sleep with head elevated 30-45 degrees
• Saline nasal irrigation for symptomatic relief 2

Decongestants (pseudoephedrine 30-60 mg every 4-6 hours) can provide temporary relief of sinus pressure and congestion. 4 However, monitor your heart rate closely given your baseline tachycardia of 130 bpm, as decongestants can increase heart rate further. 4

Critical Follow-Up Timeline

Reassess at 3-5 days: You should see improvement in fever, pain, and overall symptoms. 1, 2 If no improvement occurs, this indicates treatment failure requiring antibiotic change. 1, 2

If symptoms worsen or fail to improve by day 3-5: 1

• Switch to high-dose amoxicillin-clavulanate (if not already using it)
• Alternative: respiratory fluoroquinolone (levofloxacin 500-750 mg daily or moxifloxacin) 2
• Consider CT scan to evaluate for complications or anatomic abnormalities 1

Complete the full 10-14 day course even after symptoms improve to prevent relapse and development of chronic sinusitis. 1, 2

When to Seek Emergency Care

Go to the emergency department immediately if you develop: 3

• Severe worsening headache
• Visual changes or eye pain
• Swelling around the eyes
• Confusion or altered mental status
• Stiff neck
• Persistent high fever despite 48 hours of antibiotics

These symptoms suggest orbital or intracranial complications requiring urgent imaging and specialist consultation. 3

Common Pitfalls to Avoid

Do not stop antibiotics early even if you feel better after 5-7 days, as this leads to relapse and potential antibiotic resistance. 1, 2

Avoid using topical decongestants (nasal sprays) for more than 3 days to prevent rebound congestion. 1

Do not assume improvement means cure: Continue treatment until symptom-free for 7 days, which typically requires the full 10-14 day course. 2

Monitor your tachycardia: If heart rate remains elevated (>120 bpm) after fever resolves, or if you develop chest pain or shortness of breath, seek medical evaluation as this may indicate a separate cardiac issue. 1