From the Guidelines
The treatment for acute sinusitis should focus on supportive care, reserving antibiotics for severe or persistent cases, as most cases are self-limited and will resolve without antibiotic therapy. For mild cases, supportive care includes:
- Nasal saline irrigation
- Adequate hydration
- Over-the-counter pain relievers like acetaminophen (325-650mg every 4-6 hours) or ibuprofen (400-600mg every 6-8 hours) 1
- Nasal decongestants such as oxymetazoline can provide temporary relief but should not be used for more than 3 days to avoid rebound congestion
- Intranasal corticosteroids like fluticasone (1-2 sprays per nostril daily) may help reduce inflammation 1 Antibiotics are generally reserved for severe cases, persistent symptoms lasting over 10 days, or worsening symptoms after initial improvement. When prescribed, amoxicillin (500mg three times daily for 5-7 days) is typically the first-line antibiotic, with amoxicillin-clavulanate (875/125mg twice daily for 5-7 days) used for more complicated cases 1. Patients should complete the full course of antibiotics even if symptoms improve. Most acute sinusitis cases are viral and will resolve within 7-10 days without antibiotics. Antibiotics are only effective for bacterial infections and unnecessary use contributes to antibiotic resistance 1. Patients should seek medical attention if symptoms worsen, persist beyond 10 days, or if they develop high fever, severe headache, facial swelling, or vision changes.
The American College of Physicians and the Centers for Disease Control and Prevention recommend watchful waiting as initial management for all patients with uncomplicated acute bacterial rhinosinusitis (ABRS), regardless of severity 1. Adjunctive therapy, such as intranasal saline irrigation or intranasal corticosteroids, has been shown to alleviate symptoms and potentially decrease antibiotic use 1. A meta-analysis of adults with acute rhinosinusitis showed that the number needed to treat was 18 for 1 patient to be cured rapidly, but the number needed to harm from adverse effects from antibiotics was 8 1.
It is essential to note that the treatment approach should prioritize the patient's quality of life, minimizing morbidity and mortality. Therefore, a conservative approach with supportive care and reserved use of antibiotics is recommended, as it aligns with the principles of high-value care and minimizes the risk of antibiotic resistance 1.
From the FDA Drug Label
Levofloxacin tablets are indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis [see Clinical Studies (14.4)]. 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 The treatment for acute sinusitis is levofloxacin using either:
- 750 mg by mouth x 5 days
- 500 mg by mouth once daily x 10 to 14 days 2 2 It is effective against Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis 2
From the Research
Treatment Options for Acute Sinusitis
The treatment for acute sinusitis includes various interventions aimed at alleviating symptoms and addressing the underlying cause. Some of the treatment options are:
- Antibiotics: Amoxicillin, amoxicillin-clavulanic acid, doxycycline, cephalosporins, and macrolides are commonly used antibiotics for treating acute sinusitis 3, 4, 5.
- Antihistamines: These can help relieve symptoms such as sneezing and runny nose 3, 4.
- Decongestants: Xylometazoline, phenylephrine, and pseudoephedrine can help reduce nasal congestion 3, 4.
- Saline nasal washes: These can help clear out mucus and reduce congestion 3, 4, 5.
- Steam inhalation: This can help loosen mucus and reduce congestion 3, 4.
- Topical corticosteroids: Intranasal corticosteroids can help reduce inflammation and alleviate symptoms 3, 4.
Considerations for Antibiotic Use
Antibiotics should be considered for patients with severe symptoms, significant worsening of symptoms after 3 to 5 days, or symptoms lasting 7 or more days 5. The choice of antibiotic depends on factors such as the presence of a beta-lactam allergy, with amoxicillin being a common first-line treatment and doxycycline or a respiratory fluoroquinolone being alternatives for those with an allergy 5.
Supportive Care
Supportive care measures, including saline irrigation, nasal steroids or antihistamines, and decongestants, can help reduce the severity of symptoms and improve quality of life 5. Most episodes of rhinosinusitis are self-limited, lasting 7 to 10 days, but complications such as orbital cellulitis, meningitis, and abscess can occur, and computed tomography and referral to an otolaryngologist may be necessary in such cases 5.