What is the treatment for acute sinusitis?

From the Guidelines

Acute sinusitis treatment should prioritize symptom management with nasal saline irrigation, over-the-counter pain relievers, and intranasal corticosteroids, reserving antibiotics for severe or persistent cases. For symptom relief, start with nasal saline irrigation 2-3 times daily and over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours as needed) or ibuprofen (400-600mg every 6-8 hours with food) 1. Intranasal corticosteroids such as fluticasone (1-2 sprays per nostril daily) can help reduce inflammation and congestion. Most cases of acute sinusitis are viral and resolve within 7-10 days without antibiotics. However, if symptoms persist beyond 10 days, worsen after initial improvement, or include high fever and severe facial pain, antibiotics may be necessary. 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 severe cases or when resistance is suspected 1.

Key Considerations

• Adjunctive therapy, such as intranasal saline irrigation or intranasal corticosteroids, has been shown to alleviate symptoms and potentially decrease antibiotic use 1.
• Patients who are seriously ill, who deteriorate clinically despite antibiotic therapy, or who have recurrent episodes should be referred to a specialist (for example, an otolaryngologist, infectious disease specialist, or allergist) 1.
• Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening) 1.

Symptom Management

• Nasal saline irrigation: 2-3 times daily
• Over-the-counter pain relievers: acetaminophen (500-1000mg every 6 hours as needed) or ibuprofen (400-600mg every 6-8 hours with food)
• Intranasal corticosteroids: fluticasone (1-2 sprays per nostril daily)
• Oral decongestants: pseudoephedrine (30-60mg every 4-6 hours, not exceeding 240mg daily)

Antibiotic Use

• Amoxicillin (500mg three times daily for 5-7 days) as first-line antibiotic
• Amoxicillin-clavulanate (875/125mg twice daily for 5-7 days) for more severe cases or when resistance is suspected 1

From the FDA Drug Label

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 To evaluate the safety and efficacy of a high dose short course of levofloxacin, 780 outpatient adults with clinically and radiologically determined acute bacterial sinusitis were evaluated in a double-blind, randomized, prospective, multicenter study comparing levofloxacin 750 mg by mouth once daily for five days to levofloxacin 500 mg by mouth once daily for 10 days Clinical success rates (defined as complete or partial resolution of the pre-treatment signs and symptoms of ABS to such an extent that no further antibiotic treatment was deemed necessary) in the microbiologically evaluable population were 91.4% (139/152) in the levofloxacin 750 mg group and 88.6% (132/149) in the levofloxacin 500 mg group at the test-of-cure (TOC) visit (95% CI [-4. 2,10] for levofloxacin 750 mg minus levofloxacin 500 mg)

Treatment Options for Acute Sinusitis:

• Levofloxacin 750 mg orally once daily for 5 days
• Levofloxacin 500 mg orally once daily for 10 to 14 days Clinical Success Rates:
• 91.4% for the 5-day regimen
• 88.6% for the 10-day regimen These treatment options and success rates are based on the study results 2.

From the Research

Acute Sinusitis Treatment

• Acute bacterial sinusitis (ABS) is a common problem in both children and adults, with three clinical presentations: onset with persistent symptoms, onset with severe symptoms, and onset with worsening symptoms 3.
• The diagnosis of acute sinusitis can be confirmed with images, and the predominant bacterial species implicated are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in children 3.
• Treatment of ABS may be initiated with high-dose amoxicillin or amoxicillin-clavulanate, with alternatives including cefuroxime, cefpodoxime, or cefdinir 3.
• In cases of serious drug allergy, clarithromycin or azithromycin may be prescribed, and the optimal duration of therapy is unknown, with some recommending treatment until the patient becomes free of symptoms and then for an additional 7 days 3.

Treatment Options

• A systematic review found 19 systematic reviews, RCTs, or observational studies that met the inclusion criteria, and presented information relating to the effectiveness and safety of various interventions, including antibiotics, antihistamines, decongestants, and topical corticosteroids 4.
• Symptomatic relief with analgesics, topical or systemic decongestants, and steam inhalation may be used, and antibiotics should be given for an adequate period of time if indicated 5.
• Current treatment aims to control rhinitis and improve ventilation and function of the sinuses, with medical treatment of underlying rhinitis needing to be continued postoperatively, often in the long term 5.

Management Strategies

• Recognition and management of sinusitis involves diagnosing the condition based on symptoms, and treating with symptomatic relief and antibiotics if necessary 5.
• A review of the most current medical literature outlines the basic concepts and classifications of rhinosinusitis, and delineates best practices for clinical diagnoses and management strategies 6.
• Learning to recognize and differentiate conditions helps facilitate appropriate and timely diagnoses, as well as providing patients with better counseling and care 6.