What is the treatment for maxillary sinusitis?

From the Guidelines

Treatment of maxillary sinusitis should begin with symptomatic treatment and reassurance, with antibiotics reserved for severe or persistent cases, as most patients improve without antibiotic therapy 1. The approach to treating maxillary sinusitis involves a combination of symptomatic relief and, when necessary, antibiotic therapy.

• Symptomatic treatment includes pain management with acetaminophen or NSAIDs like ibuprofen, and decongestants such as pseudoephedrine (30-60 mg every 4-6 hours) for temporary relief, though decongestants should not be used for more than 3-5 days to avoid rebound congestion.
• Nasal saline irrigation is beneficial for clearing mucus and reducing inflammation.
• For bacterial cases, antibiotics such as amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days) can be considered, with alternatives like doxycycline (100 mg twice daily) or levofloxacin (500 mg once daily) for patients with penicillin allergies.
• The choice of antibiotic and duration of treatment should be guided by the severity of symptoms and the likelihood of bacterial infection, with a general approach of starting with amoxicillin for 3 to 5 days and adjusting based on clinical response 1.
• It's crucial to instruct patients to complete the full course of antibiotics to ensure complete eradication of the organism and prevent relapse.
• Nasal corticosteroids like fluticasone (1-2 sprays per nostril daily) or mometasone can decrease inflammation and are beneficial in reducing symptoms. The most recent and highest quality evidence supports a conservative approach to antibiotic use, emphasizing the importance of symptomatic treatment and patient education about the chosen treatment strategy 1.

From the FDA Drug Label

1.2 Acute Maxillary Sinusitis Clarithromycin extended-release tablets (in adults) are indicated for the treatment of mild to moderate infections caused by susceptible isolates due to Haemophilus influenzae, Moraxella catarrhalis,or Streptococcus pneumoniae

2.2 Adult Dosage The recommended dosages of clarithromycin extended-release tablets for the treatment of mild to moderate infections in adults are listed in Table 1. Table 1 Adult Dosage Guidelines Clarithromycin Extended-release Tablets Infection Dosage (every 24 hours) Duration (days) ... Acute maxillary sinusitis 1 gram 14

Treatment of maxillar sinusitis: Clarithromycin extended-release tablets are indicated for the treatment of mild to moderate infections caused by susceptible isolates due to Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae. The recommended dosage is 1 gram every 24 hours for 14 days 2.

From the Research

Treatment Options for Maxillary Sinusitis

• The primary treatment for maxillary sinusitis should focus on restoring the normal environment within the sinus, which can be achieved through antral puncture and lavage 3.
• Antibiotics are often prescribed, with Penicillin V being the first choice due to its effectiveness against common bacteria such as Haemophilus influenzae, Streptococcus pneumoniae, and anaerobic bacteria 3.
• In cases of therapeutic failure or allergy to penicillins, alternative antibiotics like Cefaclor, tetracyclines, or trimethoprim can be considered 3.

Role of Antibiotics in Acute Maxillary Sinusitis

• Research suggests that antibiotics provide a moderate benefit in treating acute maxillary sinusitis, with a small but significant reduction in clinical failure rates compared to placebo 4, 5, 6, 7.
• However, the clinical significance of this benefit is often debated, as a high percentage of patients improve without antibiotic treatment 4, 5, 6, 7.
• Studies have shown that about 80% of participants treated without antibiotics improve within two weeks, highlighting the need for clinicians to weigh the benefits of antibiotic treatment against potential adverse effects 6, 7.

Comparison of Antibiotic Classes

• Comparisons between different classes of antibiotics have shown no significant differences in terms of clinical cure rates 4, 5, 6.
• However, some studies have reported that amoxicillin-clavulanate has more dropouts due to adverse effects compared to cephalosporins and macrolides 6.
• The choice of antibiotic should be based on individual patient factors, such as allergy history and potential side effects 3, 6.