From the Guidelines
Acute sinusitis should be managed with supportive care, and antibiotics should be reserved for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening) 1.
Symptoms and Diagnosis
Acute sinusitis presents with symptoms including facial pain or pressure, nasal congestion, thick yellow or green nasal discharge, reduced sense of smell, fever, and headache that worsens when bending forward. Most cases are viral and resolve within 7-10 days without antibiotics.
- Facial pain or pressure
- Nasal congestion
- Thick yellow or green nasal discharge
- Reduced sense of smell
- Fever
- Headache that worsens when bending forward
Treatment
Antibiotics should be considered if symptoms persist beyond 10 days, worsen after initial improvement, or are severe with high fever and purulent discharge for 3-4 consecutive days.
- First-line antibiotic treatment is amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days
- For penicillin-allergic patients, alternatives include doxycycline 100 mg twice daily, levofloxacin 500 mg daily, or moxifloxacin 400 mg daily for 5-7 days
- Supportive measures include saline nasal irrigation, intranasal corticosteroids (fluticasone 1-2 sprays per nostril daily), analgesics for pain, and decongestants for short-term use
Targeted Pathogens
These antibiotics target common bacterial pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
Patient Management
Patients should complete the full antibiotic course even if symptoms improve and should seek medical attention if symptoms worsen or fail to improve after 3 days of antibiotics.
- Complete the full antibiotic course
- Seek medical attention if symptoms worsen or fail to improve after 3 days 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)
Acute Sinusitis Infection Symptoms and ABX Treatment Choices:
- 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% in the levofloxacin 750 mg group and 88.6% in the levofloxacin 500 mg group at the test-of-cure (TOC) visit.
- The treatment choices for acute bacterial sinusitis include levofloxacin 750 mg x 5 days or levofloxacin 500 mg x 10 to 14 days 2.
From the Research
Acute Sinusitis Infection Symptoms
- The most common presenting symptoms of acute sinusitis include nasal congestion, sinus tenderness, and purulent nasal discharge, with over 90% of patients experiencing these symptoms 3.
- Other symptoms may include headache, facial pain, and cough 4, 5.
Antibiotic Treatment Choices
- Treatment guidelines for acute bacterial sinusitis recommend 10 to 14 days of therapy with amoxicillin/clavulanate, high-dose amoxicillin, cefpodoxime, cefuroxime, or a newer fluoroquinolone 3.
- Studies have compared the efficacy of different antibiotic regimens, including:
- Gatifloxacin versus amoxicillin/clavulanate: a 5-day course of gatifloxacin was associated with comparable clinical cure rates and tolerability to a 10-day course of amoxicillin/clavulanate 3.
- High-dose versus standard-dose amoxicillin/clavulanate: some studies have suggested that high-dose amoxicillin/clavulanate may be more effective than standard-dose amoxicillin/clavulanate in achieving rapid improvement in symptoms 4, while others have found no significant difference in efficacy between the two regimens 5.
- Levofloxacin versus amoxicillin/clavulanate: levofloxacin has been shown to be as effective and better tolerated than amoxicillin/clavulanate in treating acute sinusitis 6.
- Moxifloxacin versus amoxicillin/clavulanate: moxifloxacin has been found to be statistically equivalent to amoxicillin/clavulanate in terms of clinical resolution and patient-reported outcomes, with more rapid symptomatic relief observed in the moxifloxacin group 7.