From the Guidelines
Amoxicillin alone or in combination with clavulanate is the first-line antibiotic choice for bacterial sinusitis. This recommendation is based on the American Academy of Pediatrics guideline on diagnosis and management of acute bacterial sinusitis in children one to 18 years of age 1. The guideline suggests that antibiotics should be prescribed in children with severe, worsening, or persistent acute bacterial sinusitis.
Key Points to Consider
- Amoxicillin is the preferred initial antibiotic due to its efficacy and safety profile, with the option to add clavulanate for enhanced coverage 1.
- For patients who are vomiting, cannot take oral medications, or are not likely to take the initial antibiotic doses as prescribed, intravenous or intramuscular ceftriaxone can be given as an alternative 1.
- Children with hypersensitivity to amoxicillin can be treated with cefdinir, cefuroxime, or cefpodoxime as alternative options 1.
- It is essential to complete the full course of antibiotics even if symptoms improve before finishing treatment to ensure complete eradication of the bacterial infection.
- Supportive measures like saline nasal irrigation, intranasal corticosteroids, and adequate hydration can help manage symptoms while the antibiotics work.
Treatment Approach
- The treatment approach should be individualized based on the patient's specific needs and circumstances, including the severity of symptoms, presence of comorbidities, and potential allergies to antibiotics.
- Outpatient observation for three days is also an option in children with persistent illness, allowing for close monitoring and adjustment of treatment as needed 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 (95% CI [-4. 2, 10] for levofloxacin 750 mg minus levofloxacin 500 mg).
Levofloxacin is an effective antibiotic for the treatment of acute bacterial sinusitis. The recommended treatment regimens are 750 mg by mouth once daily for 5 days or 500 mg by mouth once daily for 10 to 14 days. Clinical success rates were 91.4% for the 5-day regimen and 88.6% for the 10-day regimen 2.
From the Research
Antibiotic Treatment for Bacterial Sinusitis
- The diagnosis of acute bacterial sinusitis can be confirmed with images, and appropriate antibiotics can be prescribed to show superior outcomes in recipients of antibiotics 3.
- The predominant bacterial species implicated in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in children 3.
- Therapy may be initiated with high-dose amoxicillin or amoxicillin-clavulanate, with alternatives including cefuroxime, cefpodoxime, or cefdinir 3.
- In cases of serious drug allergy, clarithromycin or azithromycin may be prescribed 3.
Comparison of Antibiotics
- 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 in adults 4.
- Levofloxacin (500 mg orally once daily) was as effective and better tolerated than amoxicillin-clavulanate (500/125 mg orally 3 times daily) for 10 to 14 days in treating acute sinusitis in adult outpatients 5.
- Amoxicillin is as effective as amoxicillin-clavulanate as a first-line treatment for acute bacterial rhinosinusitis for those without a beta-lactam allergy 6.
Treatment Duration and Distribution
- The optimal duration of therapy is unknown, but some recommend treatment until the patient becomes free of symptoms and then for an additional 7 days 3.
- Amoxicillin and clavulanic acid spread well in ENT tissues, and 1 g twice a day of the combination seems to be clinically effective even in patients suffering from acute episodes of chronic rhinosinusitis 7.