From the Guidelines
For adults with sinus infections, treatment typically begins with symptom management using over-the-counter medications, and antibiotics should only be used when bacterial infection is likely, as they don't help viral infections and can cause side effects and contribute to antibiotic resistance.
Treatment Approach
The approach to treating sinus infections in adults involves:
- Symptom management using over-the-counter medications
- Nasal saline irrigation (using a neti pot or similar device) 1-3 times daily to help clear mucus
- Pain relievers like acetaminophen (500-1000mg every 6 hours, maximum 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food, maximum 3200mg daily) to reduce discomfort
- Decongestants such as pseudoephedrine (30mg every 4-6 hours or 120mg extended-release twice daily) may help for up to 3 days, but should be avoided by those with high blood pressure
Antibiotic Use
Most sinus infections are viral and resolve within 7-10 days without antibiotics. However, if symptoms persist beyond 10 days, worsen after initial improvement, or include severe pain, high fever, or purulent nasal discharge, antibiotics may be needed. Common antibiotic regimens include:
- Amoxicillin (500mg three times daily for 5-10 days)
- Amoxicillin-clavulanate (875/125mg twice daily for 5-10 days)
- Doxycycline (100mg twice daily for 5-10 days) for those with penicillin allergies As noted in the study by 1, the American Academy of Otolaryngology–Head and Neck Surgery emphasizes watchful waiting (without antibiotic therapy) as initial management for all patients with uncomplicated ABRS, regardless of severity.
Additional Considerations
Staying hydrated, using a humidifier, and getting adequate rest can support recovery. It is essential to consider the potential for antibiotic resistance and the lack of efficacy of antibiotics in viral infections, as highlighted in the study by 1. In cases where symptoms are severe or persistent, consultation with a specialist may be necessary, as recommended in the study by 1.
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 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)
The recommended treatment duration for acute bacterial sinusitis in adults is either 5 days with 750 mg of levofloxacin once daily or 10 to 14 days with 500 mg of levofloxacin once daily. The dosage is either 750 mg once daily for 5 days or 500 mg once daily for 10 to 14 days 2.
- Key points:
- Treatment duration: 5 days or 10 to 14 days
- Dosage: 750 mg once daily for 5 days or 500 mg once daily for 10 to 14 days
- Clinical success rates: 91.4% for 750 mg group and 88.6% for 500 mg group 2
From the Research
Sinus Infection Treatment in Adults
Timing and Dosage
- The optimal duration of therapy for acute bacterial sinusitis is unknown, but some recommend treatment until the patient becomes free of symptoms and then for an additional 7 days 3.
- Amoxicillin-clavulanate can be given every 12 hours (amoxicillin, 875 mg; clavulanate, 125 mg) or every 8 hours (amoxicillin, 500 mg; clavulanate, 125 mg) for 14 days, with similar clinical success rates 4.
- High-dose amoxicillin plus clavulanate (with double the amount of amoxicillin) may not be superior to standard-dose amoxicillin plus clavulanate in adults 5.
- Adults with clinically diagnosed acute bacterial sinusitis were more likely to improve rapidly when treated with immediate-release high-dose amoxicillin-clavulanate than with standard-dose, but not when treated with extended-release high-dose amoxicillin-clavulanate 6.
- Narrow-spectrum antibiotics such as amoxicillin should be used for 10 to 14 days to avoid the emergence and spread of antibiotic-resistant bacteria 7.
Treatment Options
- Therapy may be initiated with high-dose amoxicillin or amoxicillin-clavulanate 3.
- Alternatives include cefuroxime, cefpodoxime, or cefdinir 3.
- In cases of serious drug allergy, clarithromycin or azithromycin may be prescribed 3.
- Second-line antibiotics such as amoxicillin-clavulanate potassium and fluoroquinolones should be considered if the patient has moderate disease, recent antibiotic use, or no response to treatment within 72 hours 7.