How to treat a bacterial or viral sinus infection in a patient 16 days prior to kidney donor surgery?

Treatment of Sinus Infection 16 Days Before Kidney Donor Surgery

Surgery must be postponed until the sinus infection is completely resolved, as proceeding with active bacterial infection violates fundamental principles of surgical site infection prevention and places the donor at unnecessary risk. 1

Immediate Antibiotic Treatment

• Amoxicillin 500 mg twice daily for 10-14 days is the first-line therapy for acute bacterial sinusitis in adults, ensuring complete resolution before any surgical procedure 2, 1, 3
• High-dose amoxicillin-clavulanate (875 mg/125 mg twice daily) is preferred if the patient has recent antibiotic exposure, lives in an area with high resistance rates, or fails to improve on standard amoxicillin 2, 3
• For penicillin-allergic patients, respiratory fluoroquinolones (levofloxacin 500 mg daily or moxifloxacin 400 mg daily) are appropriate alternatives 2, 3

Timeline Considerations

• With 16 days available, there is adequate time to complete a 10-14 day antibiotic course and verify clinical resolution before surgery 2, 1
• Treatment typically produces clinical improvement within 3-5 days, with complete symptom resolution requiring 10-14 days 2
• After completing antibiotic therapy, document complete clinical resolution of all sinusitis symptoms before proceeding with surgery 1
• If symptoms persist beyond 10 days of appropriate antibiotic therapy, switch to broader-spectrum coverage (high-dose amoxicillin-clavulanate or fluoroquinolone) and extend treatment 2

Adjunctive Symptomatic Management

• Intranasal corticosteroid sprays (fluticasone, mometasone) reduce inflammation and promote sinus drainage 2, 3
• Saline nasal irrigation with physiologic or hypertonic saline provides symptomatic relief 3
• Oral or topical decongestants (pseudoephedrine, oxymetazoline) for short-term use to improve drainage, though limit topical decongestants to 3-5 days to avoid rebound congestion 2
• Adequate hydration, analgesics (acetaminophen or NSAIDs), warm facial compresses, and sleeping with head elevated 2

Critical Monitoring Points

• Reassess at 3-5 days: if symptoms worsen or fail to improve, this indicates treatment failure requiring antibiotic change 2, 1
• Worsening symptoms include progression of facial pain, fever, purulent nasal discharge, or new symptoms 2
• The transplant surgery team must be immediately informed about the infection and need for treatment completion 1

Special Considerations for Immunocompromised Transplant Recipients

While this patient is currently a healthy donor, it's worth noting that post-transplant immunosuppression dramatically increases risk of severe fungal sinusitis (mucormycosis), which presents with facial pain and can be rapidly fatal 4, 5. This underscores why complete eradication of any sinus infection before surgery is non-negotiable—the donor will become immunosuppressed if they ever need their remaining kidney transplanted in the future.

Common Pitfalls to Avoid

• Never proceed with surgery while active bacterial infection is present, regardless of schedule pressures 1
• Do not assess treatment failure prematurely (before 3-5 days), as symptom fluctuations in the first 48-72 hours are normal 1
• Do not use antibiotics for less than 10 days in this context, as incomplete treatment risks relapse immediately before or after surgery 2
• Avoid topical decongestants beyond 5 days due to rebound congestion 2

Surgical Clearance Protocol

• Confirm complete resolution of facial pain, pressure, purulent discharge, and nasal congestion 2
• Patient should be afebrile with normal energy levels 2
• Once asymptomatic for 24-48 hours after completing antibiotics, surgery can be safely rescheduled 1
• Standard surgical antibiotic prophylaxis should be administered within 120 minutes of incision once the sinus infection has resolved 1