What is the treatment of choice for bacterial sinusitis?

From the Guidelines

The treatment of choice for bacterial sinusitis is amoxicillin-clavulanate (Augmentin), typically prescribed at a dose of 45 mg/kg/day divided twice daily in children, as recommended by the American Academy of Pediatrics 1.

Key Considerations

• Amoxicillin-clavulanate is preferred over amoxicillin alone because it provides coverage against beta-lactamase-producing organisms like Haemophilus influenzae and Moraxella catarrhalis, which are common pathogens in sinusitis.
• For patients with penicillin allergy, alternatives include cefdinir, cefuroxime, or cefpodoxime, as suggested by the American Academy of Pediatrics 1.
• High-dose therapy may be necessary in areas with high prevalence of resistant Streptococcus pneumoniae.
• If symptoms worsen after 48-72 hours of treatment or fail to improve after 3-5 days, reevaluation is necessary to consider alternative antibiotics or possible complications.

Symptomatic Relief

• Saline nasal irrigation can help relieve symptoms.
• Intranasal corticosteroids like fluticasone (1-2 sprays per nostril daily) can also provide symptomatic relief.
• Analgesics can be used as needed to manage pain and discomfort.

Important Notes

• Patients should complete the full course of antibiotics even if symptoms improve earlier.
• The optimal duration of antimicrobial therapy for patients with acute bacterial sinusitis has not received systematic study, but a 10- to 14-day course of antibiotic might be adequate for most patients with acute disease, as suggested by the Journal of Allergy and Clinical Immunology 1.

From the FDA Drug Label

1.4 Acute Bacterial Sinusitis: 5 Day and 10 to 14 Day Treatment Regimens Levofloxacin tablets are indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis

1.6 Acute Bacterial Sinusitis Moxifloxacin hydrochloride tablets are indicated in adult patients (18 years of age and older) for the treatment of acute bacterial sinusitis (ABS) caused by susceptible isolates of Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis

The treatment of choice for bacterial sinusitis is levofloxacin or moxifloxacin, which are both effective against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 2 3.

• Levofloxacin can be administered as a 5-day or 10-14 day treatment regimen.
• Moxifloxacin is also an option for the treatment of acute bacterial sinusitis. It is essential to note that these antibiotics should only be used when necessary and when the infection is proven or strongly suspected to be caused by susceptible bacteria.

From the Research

Treatment Options for Bacterial Sinusitis

• Amoxicillin with clavulanate is a commonly recommended treatment for acute bacterial sinusitis in adults, as seen in the study by 4.
• The study by 5 found that amoxicillin and clavulanate given every 12 hours is as effective and safe as administration every 8 hours for the treatment of acute bacterial maxillary sinusitis.
• Alternative treatments such as levofloxacin have been shown to be as effective as amoxicillin-clavulanate, with a better tolerability profile, as reported in the study by 6.
• Azithromycin has also been compared to amoxicillin/clavulanate in the treatment of acute sinusitis, with studies by 7 and 8 showing that azithromycin can be an effective and well-tolerated treatment option.

Efficacy of Different Treatment Regimens

• The study by 4 found that adults with clinically diagnosed acute bacterial sinusitis were more likely to improve rapidly when treated with high-dose amoxicillin/clavulanate, but not when treated with extended-release high-dose amoxicillin/clavulanate.
• The study by 8 found that a single 2-g dose of azithromycin extended release resulted in faster symptom resolution compared to 10 days of amoxicillin/clavulanate.
• The study by 7 found that a 3-day course of azithromycin was as effective and well-tolerated as a 10-day course of amoxicillin/clavulanic acid in the treatment of acute sinusitis.

Safety and Tolerability

• The study by 4 found that the major side effect of high-dose amoxicillin/clavulanate was severe diarrhea, which was reported more frequently in the high-dose group.
• The study by 6 found that levofloxacin had a better tolerability profile compared to amoxicillin-clavulanate, with fewer drug-related adverse events.
• The study by 7 found that both azithromycin and amoxicillin/clavulanate were well-tolerated, with mild gastrointestinal disturbances reported by a small number of patients in both groups.