What is the appropriate treatment for a patient with chronic sinusitis and a new middle ear infection, who has recently been treated with doxycycline (doxy) and cefdinir?

From the Guidelines

For chronic sinusitis with a new middle ear infection after recent treatment with doxycycline and cefdinir, I recommend amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 10-14 days. This medication provides broader coverage against resistant bacteria that may have survived previous antibiotic treatments, as suggested by the study published in the Journal of Allergy and Clinical Immunology 1. The use of amoxicillin-clavulanate is also supported by the 2016 guidelines from the American College of Physicians and the Centers for Disease Control and Prevention, which recommend it as a preferred agent for acute bacterial rhinosinusitis 1.

Some key points to consider:

• If you have a penicillin allergy, levofloxacin 750 mg daily for 10 days would be an appropriate alternative, as it has been shown to be effective against common respiratory pathogens, including S pneumoniae and H influenzae 1.
• During treatment, use saline nasal irrigation twice daily and consider adding a nasal steroid spray like fluticasone to reduce inflammation, as recommended by the guidelines 1.
• For symptom relief, take acetaminophen or ibuprofen as needed for pain and use a decongestant like pseudoephedrine for congestion (avoid if you have high blood pressure).
• The persistence of infection despite previous antibiotics suggests possible resistant bacteria or biofilm formation, which is why a different antibiotic with beta-lactamase inhibition is recommended.
• If symptoms don't improve within 3-5 days of starting this new treatment, follow up with your healthcare provider as you may need culture-directed therapy or evaluation for underlying issues like anatomical abnormalities or immune dysfunction.

From the Research

Treatment of Chronic Sinus Infection with New Middle Ear Infection

• The patient has been treated with doxy and cefdinir for a chronic sinus infection with a new middle ear infection.
• Cefdinir is a third-generation cephalosporin with good in vitro activity against many pathogens commonly causative in community-acquired infections, including Haemophilus influenzae, Moraxella catarrhalis, and penicillin-susceptible Streptococcus pneumoniae 2.
• Cefdinir has shown good clinical and bacteriological efficacy in the treatment of mild-to-moderate infections of the respiratory tract and skin in adults, adolescents, and pediatric patients 2.
• In the treatment of acute bacterial rhinosinusitis, cefdinir has shown efficacy similar to that of other recommended regimens, including amoxicillin/clavulanate and levofloxacin 3.
• For the treatment of suppurative acute otitis media in children, cefdinir has been compared to amoxicillin/clavulanate and shown to be clinically effective, with fewer gastrointestinal adverse reactions 4.

Efficacy of Cefdinir in Middle Ear Infections

• Cefdinir has been shown to be effective in the treatment of middle ear infections, including acute otitis media 4.
• However, the efficacy of cefdinir in middle ear infections may depend on the specific pathogen and the dosage regimen used 4.
• Levofloxacin has also been used to treat middle ear diseases, including otitis media with granulation proliferation and infection of artificial materials 5.

Treatment Options for Ear Infections

• Infections of the ear, including middle ear infections, can be treated with various antibiotics, including cefdinir and amoxicillin/clavulanate 6.
• The choice of antibiotic and treatment regimen may depend on the specific diagnosis, the severity of the infection, and the patient's medical history and allergies 6.