What is the treatment for acute bacterial sinusitis secondary to bronchitis?

From the Guidelines

For acute bacterial sinusitis secondary to bronchitis, the recommended treatment is amoxicillin-clavulanate (Augmentin) 875/125 mg twice daily for 5-10 days, as it is the first-line therapy due to its effectiveness against common respiratory pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, including beta-lactamase producing strains, as stated in the clinical practice guideline update: adult sinusitis 1. This recommendation is based on randomized controlled trials with heterogeneity and noninferiority design with a preponderance of benefit over harm. For patients with penicillin allergy, alternatives include doxycycline 100 mg twice daily, levofloxacin 500 mg once daily, or moxifloxacin 400 mg once daily for the same duration. Supportive measures should include:

• Saline nasal irrigation 2-3 times daily
• Adequate hydration
• Analgesics like acetaminophen or ibuprofen for pain and fever Nasal decongestants such as oxymetazoline can provide symptomatic relief but should not be used for more than 3 consecutive days to avoid rebound congestion. If symptoms worsen after 48-72 hours of treatment or fail to improve after 7 days, reevaluation is necessary as this may indicate antibiotic resistance or complications requiring a different approach, as suggested in the clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years 1. The dual infection of sinusitis secondary to bronchitis requires addressing both conditions simultaneously, as the inflammation and infection in the lower airways can continuously seed the sinuses if not properly treated. It is also important to consider the potential for antibiotic resistance and to adjust treatment accordingly, as recommended in the guideline for the diagnosis and management of sinusitis 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 [see Clinical Studies (14.4)]. 1.5 Acute Bacterial Exacerbation of Chronic Bronchitis Levofloxacin tablets are indicated for the treatment of acute bacterial exacerbation of chronic bronchitis due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, or Moraxella catarrhalis.

Treatment for Acute Bacterial Sinusitis Secondary to Bronchitis:

• Levofloxacin is indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.
• Levofloxacin is also indicated for the treatment of acute bacterial exacerbation of chronic bronchitis due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, or Moraxella catarrhalis.
• The treatment regimens for acute bacterial sinusitis are 5 days or 10 to 14 days 2.
• It is essential to note that levofloxacin should only be used to treat infections caused by susceptible bacteria 2.

From the Research

Treatment for Acute Bacterial Sinusitis Secondary to Bronchitis

• The treatment for acute bacterial sinusitis (ABS) secondary to bronchitis typically involves the use of antibiotics, with the goal of eradicating the bacterial infection and alleviating symptoms 3, 4, 5, 6, 7.
• According to the studies, amoxicillin-clavulanate is a commonly recommended antibiotic for the treatment of ABS, including cases secondary to bronchitis 3, 4, 5, 7.
• The dosage and duration of antibiotic treatment may vary depending on the severity of the infection, the patient's age and health status, and the presence of antibiotic resistance 4, 5, 7.
• Alternative antibiotics, such as azithromycin, may also be effective in treating ABS, particularly in cases where amoxicillin-clavulanate is not suitable or effective 6.
• Supportive care, including the use of saline irrigation, nasal steroids or antihistamines, and decongestants, may also help reduce the severity of symptoms and promote recovery 5.

Antibiotic Resistance and Treatment

• The increasing rates of antimicrobial resistance among common pathogens, such as Streptococcus pneumoniae and Haemophilus influenzae, pose a significant challenge to the treatment of ABS 3, 5.
• High-dose amoxicillin-clavulanate may be effective in treating ABS caused by penicillin-resistant S. pneumoniae, but its use may also increase the risk of side effects, such as severe diarrhea 4.
• The choice of antibiotic and dosage should be guided by the patient's specific needs and the presence of antibiotic resistance, as well as the potential risks and benefits of treatment 4, 5, 7.

Diagnosis and Management

• The diagnosis of ABS is mainly clinical, based on symptoms and signs, such as persistent nasal discharge, facial pain, and fever 5, 7.
• Diagnostic testing, such as antral puncture or point-of-care testing for elevated C-reactive protein, may be helpful in some cases, but is not widely available or practical for routine use 5.
• The management of ABS should be individualized, taking into account the patient's age, health status, and the severity of the infection, as well as the presence of antibiotic resistance and other factors 5, 7.