From the Guidelines
The current favored treatment for acute maxillary sinusitis is a combination approach starting with watchful waiting for 7-10 days in mild cases, as most cases resolve spontaneously. If symptoms persist or are severe, amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days) is the first-line antibiotic due to increasing bacterial resistance to amoxicillin alone 1. For penicillin-allergic patients, doxycycline (100 mg twice daily) or a respiratory fluoroquinolone like levofloxacin (750 mg daily) can be used. Symptomatic relief includes:
- intranasal corticosteroids (such as fluticasone 1-2 sprays per nostril daily)
- saline nasal irrigation (using distilled water with premade packets 1-2 times daily)
- analgesics like acetaminophen or ibuprofen for pain and inflammation. Decongestants like pseudoephedrine may provide short-term relief but should be limited to 3-5 days to avoid rebound congestion. This approach targets the underlying bacterial infection while managing inflammation and promoting drainage of the sinuses. Patients should increase fluid intake and consider using a humidifier to keep mucus thin. If symptoms worsen or don't improve after treatment, further evaluation may be needed to rule out complications or resistant infections, as suggested by the American College of Physicians and the Centers for Disease Control and Prevention 1.
From the FDA Drug Label
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)]. 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
The current favored treatment for acute maxillary sinusitis is levofloxacin 750 mg by mouth once daily for five days or levofloxacin 500 mg by mouth once daily for 10 to 14 days 2.
- Key points:
- The treatment is effective against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
- The clinical success rates are 91.4% for the 5-day regimen and 88.6% for the 10-day regimen.
From the Research
Current Favored Treatment for Acute Maxillary Sinusitis
The current favored treatment for acute maxillary sinusitis involves the use of antibiotics. The choice of antibiotic depends on various factors, including the severity of the infection, the presence of allergies, and the likelihood of resistance.
- First-line treatment: High-dose amoxicillin or amoxicillin-clavulanate is often recommended as the first-line treatment for acute maxillary sinusitis 3.
- Alternative treatments: For patients who are allergic to penicillin or have failed to respond to amoxicillin, alternative treatments such as cefuroxime, cefpodoxime, or cefdinir may be used 3, 4.
- Dosing frequency: Studies have shown that administering amoxicillin-clavulanate every 12 hours is as effective as administering it every 8 hours 5.
- Eradication of pathogens: High-dose amoxicillin-clavulanate (4.0 g/day) has been shown to be more effective than low-dose amoxicillin-clavulanate (1.5 g/day) in eradicating Streptococcus pneumoniae from the nasopharynx 6.
- Comparison of antibiotics: Cefdinir has been shown to be as effective as amoxicillin-clavulanate in the treatment of acute community-acquired bacterial sinusitis, with similar clinical response rates and microbiologic eradication rates 4.
- Safety and efficacy: Cefuroxime axetil has been shown to be as effective as amoxicillin-clavulanate in the treatment of acute bacterial maxillary sinusitis, with fewer adverse effects 7.