From the Guidelines
For recurrent sinus infections with new ear pain after doxycycline and cefdinir treatment, you should see an ENT specialist for evaluation and consider amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 10-14 days as an alternative antibiotic option. This combination of symptoms suggests possible antibiotic resistance or an underlying structural issue. The most recent and highest quality study, 1, recommends amoxicillin-clavulanate as the preferred agent for acute bacterial rhinosinusitis.
Key Considerations
- Recurrent infections often indicate biofilm formation, where bacteria create protective shields against antibiotics, or anatomical issues like deviated septum or narrow sinus openings that impair drainage.
- The ear pain could represent spread of infection to the middle ear through the Eustachian tube, which connects your middle ear to your throat and can become blocked during sinus infections.
- Nasal saline irrigation with a Neti pot twice daily can help clear mucus and reduce inflammation.
- For ear pain, over-the-counter pain relievers like ibuprofen (400-600 mg every 6 hours) or acetaminophen (650 mg every 6 hours) may provide relief.
- Use a warm compress on the affected ear for 15 minutes several times daily.
Additional Recommendations
- Consider consultation with an allergist-immunologist for treatment of underlying allergic factors and evaluation of unusual pathogens and immunodeficiency, as suggested by 1.
- A sinus CT scan may be necessary to evaluate underlying structural issues, as recommended by 1.
- The use of broader-spectrum single agents, such as high-dose amoxicillin-potassium clavulanate, cefuroxime, or cefpodoxime, should be considered with or without the addition of anaerobic coverage with clindamycin or metronidazole, as suggested by 1 and 1.
From the Research
Recurrent Sinus Infections and New Ear Pain
- The patient has been treated with doxy and cefdinir for recurrent sinus infections and new ear pain.
- According to the study 2, acute bacterial sinusitis (ABS) is a common problem in both children and adults, and the predominant bacterial species implicated in ABS are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
- The study 2 also suggests that therapy may be initiated with high-dose amoxicillin or amoxicillin-clavulanate, and alternatives include cefuroxime, cefpodoxime, or cefdinir.
- Cefdinir has been shown to be effective in the treatment of acute community-acquired bacterial sinusitis (ACABS) in studies 3 and 4, with similar clinical response rates to amoxicillin-clavulanate.
- The study 3 compared cefdinir to amoxicillin-clavulanate in the treatment of ACABS and found that cefdinir was as effective clinically, with approximately 90% cure rate, and had similar microbiologic eradication rates.
- The study 4 evaluated the efficacy and safety of cefdinir in the treatment of maxillary sinusitis and found that cefdinir was therapeutically as effective as or better than amox/clav, although cefdinir BD was not as useful as amox/clav clinically.
- The classification and treatment of rhinosinusitis have been updated in recent years, with a focus on evidence-based guidelines 5 and 6.
- The goals of treatment for rhinosinusitis include reduction of mucosal edema, reestablishment of sinus ventilation, and eradication of infecting pathogens, and multiple therapies are available, including antibiotics, saline irrigations, and topical and systemic glucocorticoids 5.