What is a good antibiotic for acute sinusitis (sinus infection)?

From the Guidelines

Amoxicillin-clavulanate is the preferred antibiotic for treating acute bacterial rhinosinusitis (ABRS), as it is effective against resistant bacteria, with a recommended dose of 875mg/125mg twice daily for 5-10 days. For patients allergic to penicillin, alternatives include doxycycline (100mg twice daily) or trimethoprim-sulfamethoxazole (one double-strength tablet twice daily) 1. It's essential to note that most sinus infections are viral and resolve without antibiotics within 7-10 days, so antibiotics should only be used for bacterial infections, typically diagnosed when symptoms last more than 10 days, are severe, or worsen after initial improvement 1. While taking antibiotics, it's crucial to stay hydrated, complete the full course even if feeling better, and consider saline nasal irrigation and over-the-counter pain relievers to help manage symptoms.

Some key points to consider when treating sinus infections include:

• Using clinical signs and symptoms to differentiate bacterial from viral causes, as radiographic imaging has no role in ascertaining a bacterial cause 1
• Reserving antibiotic treatment for patients with persistent symptoms for more than 10 days without clinical improvement, severe symptoms, or symptoms that worsen after an initial period of improvement 1
• Considering adjunctive therapy, such as intranasal saline irrigation or intranasal corticosteroids, to alleviate symptoms and potentially decrease antibiotic use 1

It's also important to note that the predicted spontaneous resolution rate for clinically diagnosed sinusitis in untreated adults with ABRS is 62%, and antibiotics can be placed into a relative rank order of predicted clinical efficacy, with amoxicillin-clavulanate being one of the most effective options 1. However, the choice of antibiotic should always be based on the individual patient's needs and medical history.

From the FDA Drug Label

Acute Bacterial Sinusitis In a randomized, double blind, double-dummy controlled clinical trial of acute bacterial sinusitis, azithromycin (500 mg once daily for 3 days) was compared with amoxicillin/clavulanate (500/125 mg tid for 10 days). The primary endpoint of this trial was prospectively defined as the clinical cure rate at Day 28 For the 594 patients analyzed in the modified intent to treat analysis at the Day 10 visit, the clinical cure rate for 3 days of azithromycin was 88% (268/303) compared to 85% (248/291) for 10 days of amoxicillin/clavulanate. The overall incidence of treatment-related adverse events, primarily gastrointestinal, was lower in the azithromycin treatment arm (31%) than in the amoxicillin/clavulanate arm (51%).

Azithromycin is a good antibiotic for sinus infection, with a clinical cure rate of 88% at Day 10 and 71.5% at Day 28, and a lower incidence of treatment-related adverse events compared to amoxicillin/clavulanate 2.

• The recommended dose for adults is 500 mg once daily for 3 days.
• The most common side effects are diarrhea, nausea, and abdominal pain.
• For pediatric patients, the recommended dose is 10 mg/kg once daily for 3 days 2.

From the Research

Antibiotic Options for Sinus Infection

• Azithromycin and amoxicillin/clavulanate are commonly used antibiotics for treating sinus infections 3, 4, 5.
• A study comparing azithromycin and amoxicillin/clavulanate found that azithromycin had a faster resolution of symptoms and was as effective as amoxicillin/clavulanate in treating acute sinusitis 3.
• Another study found that azithromycin extended release had a higher symptom resolution rate at 5 days compared to amoxicillin/clavulanate, without differences in second antibiotic use at 28 days 5.

Comparison of Amoxicillin and Amoxicillin-Clavulanate

• A retrospective cohort study found that amoxicillin and amoxicillin-clavulanate had similar effectiveness in treating acute sinusitis, with no difference in sinusitis-related return visits 6.
• The study also found that amoxicillin had fewer gastrointestinal-related adverse events compared to amoxicillin-clavulanate 6.
• Amoxicillin is considered a viable option for adults with acute sinusitis who meet criteria for antibiotic therapy, with similar efficacy to amoxicillin-clavulanate and fewer gastrointestinal-related adverse events 6.

Treatment Guidelines

• The use of penicillin or amoxicillin for 7 to 14 days is supported by current evidence for the treatment of acute maxillary sinusitis confirmed radiographically or by aspiration 4.
• Clinicians should weigh the moderate benefits of antibiotic treatment against the potential for adverse effects when deciding on a treatment plan 4.