From the Guidelines
For a sinus infection that hasn't responded to Augmentin, I recommend switching to a different antibiotic such as high-dose amoxicillin-potassium clavulanate (875mg/125mg twice daily) or cefuroxime, as these options are more likely to cover resistant bacteria, as suggested by 1. When considering treatment options for a sinus infection that is refractory to Augmentin, it's essential to consider the potential causes of treatment failure, such as resistant bacteria or atypical pathogens.
- The use of broader-spectrum single agents, such as high-dose amoxicillin-potassium clavulanate or cefuroxime, should be considered, as recommended by 1.
- Adding a nasal steroid spray like fluticasone (2 sprays in each nostril daily) and saline nasal irrigation twice daily can help reduce inflammation and improve drainage.
- Decongestants such as pseudoephedrine 60mg every 6 hours (if no contraindications) for 3-5 days may also provide symptomatic relief.
- If symptoms persist beyond 7-10 days of appropriate antibiotic therapy, consider referral to an ENT specialist for evaluation of possible complications, anatomical issues, or chronic sinusitis, as suggested by 1.
- Bacterial biofilms or fungal infections might be present in refractory cases, requiring more specialized treatment approaches. It's also important to note that consultation with a specialist should be sought when sinusitis is refractory to the usual antibiotic treatment, as recommended by 1.
From the FDA Drug Label
In the second study, 264 patients were enrolled in a prospective, multi-center, non-comparative trial of 500 mg levofloxacin administered orally or intravenously once daily for 7 to 14 days. 14. 4 Acute Bacterial Sinusitis: 5 Day and 10 to 14 Day Treatment Regimens 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
Treatment of Sinus Infection Refractory with Augmentin:
- Levofloxacin can be used as an alternative treatment for acute bacterial sinusitis (ABS) in patients who are refractory to Augmentin.
- The recommended dosage is 750 mg by mouth x 5 days or 500 mg by mouth once daily x 10 to 14 days.
- Clinical success rates 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 2.
From the Research
Treatment Options for Sinus Infection Refractory with Augmentin
- Augmentin, also known as amoxicillin-clavulanate, is a common antibiotic used to treat sinus infections 3, 4, 5, 6.
- However, some strains of bacteria that cause sinus infections, such as Haemophilus influenzae and Moraxella catarrhalis, may produce beta-lactamases, which can make them resistant to Augmentin 3, 4.
- In such cases, alternative antibiotics such as levofloxacin, cefuroxime, cefpodoxime, or cefdinir may be effective 4, 5, 6.
- A study comparing levofloxacin and amoxicillin-clavulanate found that both treatments were effective in treating acute sinusitis, but levofloxacin had a better tolerability profile 5, 6.
Bacteriological Efficacy of Alternative Antibiotics
- Levofloxacin has been shown to have a high eradication rate for major pathogens of acute sinusitis, including H. influenzae, S. pneumoniae, and S. aureus 5, 6.
- Cefuroxime, cefpodoxime, and cefdinir are also effective against a range of bacterial pathogens, including those that produce beta-lactamases 4.
- However, the choice of antibiotic should be based on the specific bacterial pathogen and the patient's medical history and allergies 4, 7.
Clinical Evidence for Antibiotic Treatment
- A systematic review of 63 studies found that antibiotics provided a small benefit for clinical outcomes in immunocompetent primary care patients with uncomplicated acute sinusitis 7.
- However, the review also found that about 80% of participants treated without antibiotics improved within two weeks, highlighting the need to weigh the benefits of antibiotic treatment against the potential for adverse effects 7.