What are the best antibiotics (abx) for treating sinusitis?

From the Guidelines

For acute bacterial sinusitis, amoxicillin-clavulanate is the preferred antibiotic treatment, but it should be reserved for patients with persistent symptoms for more than 7-10 days or those with severe disease, as most cases are self-limited and resolve without antibiotics. The decision to use antibiotics should be based on clinical criteria, and the American College of Physicians and the Centers for Disease Control and Prevention recommend amoxicillin-clavulanate as the first-line treatment 1. The recommended dosage is typically 875/125 mg taken orally twice daily for 5-7 days in most uncomplicated cases.

• Key considerations for antibiotic treatment include:
  • Coverage against common bacterial pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis
  • Potential for antibiotic resistance, particularly in areas with high prevalence of penicillin-resistant Streptococcus pneumoniae
  • Patient factors, such as penicillin allergy, which may require alternative treatments like doxycycline or a respiratory fluoroquinolone
• Adjunctive therapies, such as intranasal saline irrigation or intranasal corticosteroids, can be helpful in alleviating symptoms and potentially decreasing antibiotic use 1.
• It is essential to note that most patients with acute rhinosinusitis have more adverse effects than benefits from antibiotics, and the number needed to harm from adverse effects is lower than the number needed to treat 1. Therefore, watchful waiting and supportive care are recommended as initial management for all patients with uncomplicated acute bacterial sinusitis, regardless of severity.

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)

The best antibiotic for sinusitis is Levofloxacin, with a 5-day treatment regimen of 750 mg by mouth once daily showing a 91.4% clinical success rate, and a 10-14 day treatment regimen of 500 mg by mouth once daily showing an 88.6% clinical success rate 2.

From the Research

Treatment Options for Acute Bacterial Sinusitis

• Amoxicillin/clavulanate is a commonly recommended treatment for acute bacterial sinusitis, with a typical duration of 10 to 14 days 3, 4, 5, 6
• Gatifloxacin has been shown to be effective in treating acute bacterial sinusitis, with a shorter course of 5 days being comparable to a 10-day course of amoxicillin/clavulanate 3
• Other antibiotics such as cefdinir, doxycycline, and respiratory fluoroquinolones may also be effective in treating acute bacterial sinusitis 7, 4, 5
• The choice of antibiotic should be based on the severity of symptoms, patient allergies, and local resistance patterns 4, 6

Duration of Treatment

• The traditional duration of treatment for acute bacterial sinusitis is 10 to 14 days, but some studies suggest that a shorter course of 5 days may be sufficient 3, 7
• The duration of treatment should be individualized based on the patient's response to therapy and the severity of symptoms 7, 4

Supporting Evidence

• A study published in Clinical Therapeutics found that a 5-day course of gatifloxacin was comparable to a 10-day course of amoxicillin/clavulanate in treating acute bacterial sinusitis 3
• A review published in Treatments in Respiratory Medicine found that short-course antibiotic therapy may be effective in treating acute bacterial sinusitis, with a 5-day course being sufficient in some cases 7
• A study published in Antimicrobial Agents and Chemotherapy found that cefdinir was as effective as amoxicillin/clavulanate in treating acute community-acquired bacterial sinusitis 5
• A review published in American Family Physician found that amoxicillin is as effective as amoxicillin/clavulanate as a first-line treatment for acute bacterial rhinosinusitis 4