From the Guidelines
For acute sinusitis, treatment begins with symptom management, and antibiotics such as amoxicillin or amoxicillin-clavulanate may be prescribed if symptoms persist beyond 10 days, worsen after initial improvement, or include high fever and severe facial pain, as indicated by 1.
Key Considerations
- Most cases of acute sinusitis resolve within 7-10 days without antibiotics as they're typically viral.
- Symptom management includes nasal saline irrigation, over-the-counter pain relievers like acetaminophen or ibuprofen, and decongestants such as pseudoephedrine.
- Intranasal corticosteroids like fluticasone can reduce inflammation.
- For chronic sinusitis lasting over 12 weeks, longer courses of antibiotics, extended use of intranasal steroids, or referral to an ENT specialist for possible surgical intervention might be necessary.
Treatment Approach
- Maintain hydration, use a humidifier, and avoid irritants like cigarette smoke to prevent recurrence by keeping mucus thin and promoting drainage.
- Consider surgical intervention for conditions such as nasal polyps, recurrent or persistent infectious sinusitis, or anatomic defects that obstruct the sinus outflow tract, as suggested by 1.
Antibiotic Use
- Antibiotics should be prescribed for severe, worsening, or persistent acute bacterial sinusitis, with amoxicillin alone or in combination with clavulanate as the first-line antibiotic choice, as recommended by 1.
- For patients with hypersensitivity to amoxicillin, alternative antibiotics such as cefdinir, cefuroxime, or cefpodoxime may be used.
From the Research
Definition and Prevalence of Sinusitis
- Sinusitis is defined pathologically as transient inflammation of the mucosal lining of the paranasal sinuses lasting less than 4 weeks 2.
- Clinically, it is characterized by nasal congestion, rhinorrhoea, facial pain, hyposmia, sneezing, and, if more severe, additional malaise and fever 2.
- It affects 1% to 5% of the adult population each year in Europe 2.
Treatment of Sinusitis
- A systematic review found 19 systematic reviews, RCTs, or observational studies that met the inclusion criteria for the treatment of acute sinusitis, including antibiotics, antihistamines, decongestants, saline nasal washes, steam inhalation, and topical corticosteroids 2.
- A comparative trial found that levofloxacin is as effective and better tolerated than amoxicillin-clavulanate for treating acute sinusitis in adult outpatients 3.
- A retrospective cohort study found that amoxicillin demonstrated similar efficacy to amoxicillin-clavulanate for acute sinusitis with fewer gastrointestinal-related adverse events 4.
Antibiotic Prescription Patterns
- A study found that despite published guidelines recommending amoxicillin with or without clavulanic acid as first-line treatment for acute rhinosinusitis, only 42.2% of prescribed antibiotics followed this guideline 5.
- The most common initial antibiotics prescribed for acute rhinosinusitis were erythromycins/macrolides, amoxicillin/clavulanate, amoxicillin, third generation cephalosporins, quinolones, and tetracyclines 5.
- The study suggests that further investigation into the causes of erythromycin/macrolide prescriptions as first line treatment for acute rhinosinusitis and practices at other institutions should be conducted 5.
Management Strategies
- A review article outlines the basic concepts and classifications of rhinosinusitis, and delineates best practices for clinical diagnoses and the most up-to-date management strategies 6.
- Learning to recognize and differentiate these conditions helps facilitate appropriate and timely diagnoses as well as helping practitioners provide their patients with better counseling and care 6.