From the Guidelines
Acute sinusitis infection should be treated with amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days for most adults. The symptoms of acute sinusitis include facial pain or pressure, nasal congestion, purulent nasal discharge, decreased sense of smell, and possibly fever, headache, fatigue, dental pain, and cough.
Key Points to Consider
- The choice of antibiotic should be based on the severity of symptoms and the presence of risk factors for resistant organisms 1.
- For penicillin-allergic patients, alternatives include doxycycline, levofloxacin, or moxifloxacin 1.
- Consider high-dose amoxicillin-clavulanate for patients with risk factors for resistant organisms, recent antibiotic use, or in areas with high S. pneumoniae resistance.
- Antibiotics should be reserved for patients with severe symptoms, symptoms lasting more than 10 days without improvement, or worsening symptoms after initial improvement.
- Supportive care with saline nasal irrigation, intranasal corticosteroids, analgesics, and decongestants can help manage symptoms.
Common Bacterial Pathogens
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis Amoxicillin-clavulanate provides coverage against beta-lactamase producing organisms that cause resistance to amoxicillin alone 1.
Duration of Treatment
- 5-7 days for uncomplicated cases
- 10-14 days for severe cases It is essential to note that acute uncomplicated rhinosinusitis is a self-limited infection that usually resolves without antibiotics, even in patients with a bacterial cause 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. 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
Recommended Antibiotic Choices for Acute Sinusitis:
- Azithromycin: 500 mg once daily for 3 days
- Levofloxacin: 750 mg once daily for 5 days or 500 mg once daily for 10 to 14 days Key Points:
- Azithromycin and levofloxacin are both effective treatment options for acute bacterial sinusitis.
- The recommended dosage and duration of treatment vary depending on the antibiotic chosen.
- It is essential to consult the FDA drug label for specific dosage instructions and potential interactions 2, 3.
From the Research
Acute Sinusitis Infection Symptoms and Signs
- Onset with persistent symptoms (nasal symptoms or cough or both for > 10 but < 30 d without evidence of improvement) 4
- Onset with severe symptoms (high fever and purulent nasal discharge for 3-4 consecutive days) 4
- Onset with worsening symptoms (respiratory symptoms, with or without fever, which worsen after several days of improvement) 4
- Unilateral facial pain or pressure, fever greater than 102°F (39°C), and purulent nasal discharge with obstruction of the nasal passages 5
Recommended Antibiotic Choices
- High-dose amoxicillin or amoxicillin-clavulanate as first-line treatment 4, 6, 7
- Amoxicillin-clavulanate for penicillin-allergic patients or those who are unresponsive to amoxicillin 4
- Alternatives include cefuroxime, cefpodoxime, or cefdinir 4
- Clarithromycin or azithromycin for cases of serious drug allergy 4
- Doxycycline or a respiratory fluoroquinolone for patients with a beta-lactam allergy 5
- Clindamycin plus a third-generation cephalosporin for children with non-type I hypersensitivity to beta-lactam antibiotics 5