From the Guidelines
If your sinusitis symptoms have persisted for over a month, you should see a healthcare provider for proper evaluation and treatment. According to the guidelines for the diagnosis and management of sinusitis 1, chronic sinusitis is defined as symptoms persisting for 8 weeks or longer, and it may require prescription medications. Your doctor might prescribe antibiotics like amoxicillin-clavulanate (875/125 mg twice daily for 10-14 days) if bacterial infection is suspected, as suggested in the practice parameter update 1.
Key Considerations
- Prescription-strength nasal corticosteroids such as fluticasone (1-2 sprays per nostril daily) or mometasone can reduce inflammation, as indicated in the management of sinusitis 1.
- Oral steroids like prednisone (short course of 5-7 days) might be needed for severe cases, especially if there is a suspicion of chronic hyperplastic eosinophilic sinusitis, which does not respond to antibiotics 1.
- In the meantime, continue using saline nasal irrigation twice daily, take over-the-counter decongestants (but not for more than 3 days), and use pain relievers like acetaminophen or ibuprofen as needed.
- Persistent sinusitis may indicate structural issues like nasal polyps or deviated septum, chronic allergies, or resistant infections that require specialized treatment, as outlined in the indications for surgical intervention 1.
Additional Recommendations
- Humidity, adequate hydration, and avoiding irritants can provide some relief while awaiting medical care.
- Evaluation should include coronal sinus CT with extra cuts through the ostiomeatal complex to clarify the extent of disease and specific location or locations, as recommended in the diagnosis and management of sinusitis 1.
- Consideration of noninfectious forms of sinusitis, such as chronic hyperplastic eosinophilic sinusitis, is crucial, as it may require a different treatment approach, including a course of systemic corticosteroids 1.
From the FDA Drug Label
1.3 Sinusitis – caused by beta-lactamase–producing isolates of H. influenzae and M. catarrhalis. The FDA drug label does not answer the question.
From the Research
Sinusitis Treatment and Duration
- The duration of sinusitis can vary, and it's not uncommon for symptoms to persist for several weeks or even months 2.
- According to a study published in 1999, the success rates for treating acute sinusitis with levofloxacin or amoxicillin-clavulanate were 88.4% and 87.3%, respectively, 2 to 5 days after the end of treatment 3.
- Another study published in 1994 found that ciprofloxacin was as effective as amoxycillin/clavulanic acid in treating chronic sinusitis, with a clinical cure rate of 58.6% versus 51.2% 4.
Factors Affecting Sinusitis Duration
- The type and severity of sinusitis, as well as the effectiveness of treatment, can impact the duration of symptoms 2.
- A study published in 2004 found that levofloxacin and amoxicillin/clavulanic acid had similar clinical efficacy and bacteriological response in the treatment of purulent sinusitis 5.
- The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends distinguishing between acute and chronic sinusitis, as well as assessing pain and providing analgesic treatment based on severity 2.
Management and Treatment Options
- The primary purpose of the clinical practice guideline for adult sinusitis is to improve diagnostic accuracy, reduce inappropriate antibiotic use, and promote appropriate use of ancillary tests 2.
- A review of the current medical literature outlines the basic concepts and classifications of rhinosinusitis, and delineates best practices for clinical diagnoses and management strategies 6.
- Treatment options for sinusitis may include antibiotics, such as amoxicillin or levofloxacin, as well as symptomatic relief and control measures 2, 5.