From the Guidelines
For acute bacterial sinusitis, antibiotics should be prescribed in children with severe, worsening, or persistent symptoms, with amoxicillin alone or in combination with clavulanate being the first-line antibiotic choice. Sinusitis is an inflammation of the sinus cavities, typically caused by viral infections, bacterial infections, or allergies. For acute sinusitis, treatment begins with symptom management including saline nasal irrigation, over-the-counter pain relievers like acetaminophen or ibuprofen (400-600mg every 6-8 hours), and decongestants such as pseudoephedrine (30-60mg every 4-6 hours, not exceeding 240mg daily) 1. Intranasal corticosteroids like fluticasone (1-2 sprays per nostril daily) can reduce inflammation. Most cases resolve within 7-10 days without antibiotics as they're typically viral. 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 (500mg three times daily for 5-7 days) or amoxicillin-clavulanate (875/125mg twice daily for 5-7 days) may be prescribed, as recommended by the American Academy of Pediatrics 1.
Some key points to consider in the management of sinusitis include:
- The use of antibiotics should be reserved for cases where bacterial infection is suspected, and symptoms have persisted or worsened over time 1.
- Intranasal corticosteroids can be used as an adjunct to antibiotic therapy to help reduce inflammation and improve symptoms 1.
- Referral to an ENT specialist may be necessary for cases of chronic sinusitis or medically resistant sinusitis, especially if symptoms significantly affect performance and quality of life 1.
- Preventing sinusitis involves avoiding allergens, maintaining good hand hygiene, staying hydrated, and using humidifiers in dry environments.
It's also important to note that the role of antibiotics in chronic sinusitis is controversial, and the use of antibiotics should be tailored to the individual patient's needs and circumstances, with consideration given to anaerobic pathogens and the potential need for longer durations of therapy 1.
From the FDA Drug Label
Acute bacterial sinusitis 500 mg QD × 3 days The recommended dose of azithromycin for oral suspension for the treatment of pediatric patients with acute bacterial sinusitis is 10 mg/kg once daily for 3 days.
The recommended dose of azithromycin for the treatment of acute bacterial sinusitis is:
- 500 mg once daily for 3 days in adults
- 10 mg/kg once daily for 3 days in pediatric patients 2
From the Research
Definition and Diagnosis of Sinusitis
- Sinusitis is a clinical diagnosis, and distinguishing between bacterial and viral sinusitis can be challenging 3
- Cardinal features of acute bacterial rhinosinusitis include unilateral facial pain or pressure, fever greater than 102°F (39°C), and purulent nasal discharge with obstruction of the nasal passages 3
Treatment of Sinusitis
- Antibiotics should be considered for patients with 3 or more days of severe symptoms, significant worsening after 3 to 5 days of symptoms, or 7 or more days of symptoms 3
- Amoxicillin is as effective as amoxicillin-clavulanate as a first-line treatment for acute bacterial rhinosinusitis for those without a beta-lactam allergy 3
- High-dose amoxicillin/clavulanate may be more effective than standard-dose amoxicillin/clavulanate in adults with clinically diagnosed acute bacterial sinusitis, but further study is needed to confirm these findings 4, 5
- A short course (5 days) of gatifloxacin therapy was associated with comparable clinical cure rates and tolerability to those of standard 10-day therapy with gatifloxacin or amoxicillin/clavulanate in patients with acute, uncomplicated sinusitis 6
Distribution and Efficacy of Antibiotics
- Amoxicillin and clavulanic acid spread well in ENT tissues, and 1 g twice a day of the combination seems to be clinically effective even in patients suffering from acute episodes of chronic rhinosinusitis 7
- The tissue levels of both amoxicillin and clavulanic acid in the time period within 2-6 h after administration were higher than the Minimum Inhibitory Concentration (MIC) for the most frequent causative pathogens of sinus bacterial infections 7