From the Guidelines
The treatment for acute sinusitis typically involves symptomatic relief and antimicrobial therapy only when necessary.
Treatment Approach
For patients with mild symptoms, treatment and reassurance are the preferred initial treatment strategy 1.
- Pain medications and decongestants can be offered to ease nasal symptoms and facial pain and promote mucous clearance 1.
- Nasal decongestants such as oxymetazoline (0.05% solution, 2-3 sprays per nostril twice daily) and pain relievers like acetaminophen (650-1000mg every 4-6 hours) or ibuprofen (200-400mg every 4-6 hours) may be used to alleviate symptoms.
Antibiotic Therapy
For patients with severe symptoms or those who do not improve with symptomatic treatment, antibiotic therapy may be necessary 1.
- A 5- to 7-day course of amoxicillin (500mg three times daily) or doxycycline (100mg twice daily) is recommended for initial antibiotic therapy 1.
- In cases of persistent symptoms or high-risk patients, a 10- to 14-day course of antibiotics may be necessary 1.
Adjunctive Therapy
Additional therapies that may provide symptomatic relief include:
- Intranasal saline irrigation
- Intranasal corticosteroids
- Mucolytics
- Antihistamines tailored to the patient's symptoms 1.
Specialist Referral
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.
From the FDA Drug Label
Acute bacterial sinusitis 500 mg QD × 3 days The treatment for acute sinusitis is azithromycin 500 mg once daily for 3 days 2.
- The clinical cure rate for 3 days of azithromycin was 88% (268/303) compared to 85% (248/291) for 10 days of amoxicillin/clavulanate at Day 10.
- The clinical cure rate for 3 days of azithromycin was 71.5% (213/298) compared to 71.5% (206/288) for 10 days of amoxicillin/clavulanate at Day 28. For pediatric patients, the recommended dose of azithromycin for oral suspension for the treatment of acute bacterial sinusitis is 10 mg/kg once daily for 3 days 2.
From the Research
Treatment Options for Acute Sinusitis
The treatment for acute sinusitis typically involves the use of antibiotics, with the goal of resolving symptoms and eradicating the underlying bacterial infection. Some of the commonly recommended antibiotics for acute sinusitis include:
- Amoxicillin/clavulanate 3, 4, 5, 6
- Gatifloxacin 3
- Azithromycin 5, 6
- Cefuroxime, cefpodoxime, or cefdinir 4
- Clarithromycin or azithromycin for patients with serious drug allergies 4
Duration of Therapy
The optimal duration of therapy for acute sinusitis is unknown, but treatment is typically continued until the patient becomes free of symptoms and then for an additional 7 days 4. Some studies have investigated shorter courses of therapy, such as a 5-day course of gatifloxacin 3 or a 3-day course of azithromycin 5, with comparable clinical cure rates and tolerability to standard 10-day regimens.
Efficacy of Antibiotics
While there is some controversy in the literature regarding the effectiveness of antibiotics in the treatment of acute sinusitis, most studies suggest that antibiotics are beneficial in resolving symptoms and eradicating the underlying bacterial infection 3, 4, 5, 6. However, one study found that neither an antibiotic nor a topical steroid alone or in combination was effective as a treatment for acute sinusitis in the primary care setting 7.
Topical Nasal Steroids
Topical nasal steroids, such as budesonide, may be beneficial in reducing inflammation and improving symptoms in patients with acute sinusitis, particularly those with less severe symptoms at baseline 7. However, the evidence for their use is limited, and further studies are needed to fully understand their role in the treatment of acute sinusitis.