What is the treatment plan for Acute Sinusitis?

From the Guidelines

Treatment Plan for Acute Sinusitis

The treatment plan for acute sinusitis typically involves a combination of antimicrobial therapy and symptomatic relief.

• First-line antibiotic treatment consists of amoxicillin 500mg orally three times daily for 10-14 days, or doxycycline 100mg orally twice daily for 10-14 days in patients with penicillin allergy, as supported by 1.
• Additionally, nasal decongestants such as oxymetazoline 0.05% nasal spray may be used for up to 3 days to alleviate nasal congestion, and pain management with acetaminophen 650mg orally every 4-6 hours as needed.
• It is also important to note that watchful waiting without antibiotic therapy may be considered as initial management for patients with uncomplicated acute sinusitis, as recommended by 1.
• Intranasal saline irrigation or intranasal corticosteroids may also be used as adjunctive therapy to alleviate symptoms and potentially decrease antibiotic use, as suggested by 1.
• Patients who are seriously ill, who deteriorate clinically despite antibiotic therapy, or who have recurrent episodes should be referred to a specialist, such as an otolaryngologist, infectious disease specialist, or allergist, as advised by 1.
• The goals of antimicrobial therapy for acute sinusitis are to eradicate the causative pathogens, provide symptomatic relief, restore and improve sinus function, and prevent intracranial complications and chronic sequelae, as outlined in 1.
• The choice of antibiotic should be based on the likely pathogens, including H. influenzae, S. pneumoniae, and M. catarrhalis, and should be guided by local resistance patterns and patient factors, such as allergy history, as discussed in 1.

From the FDA Drug Label

For more severe infections and infections of the respiratory tract, the dose should be one 875 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours or one 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours. Table 1: Dosing in Patients Aged 12 weeks (3 months) and Older INFECTION | DOSING REGIMEN | Every 12 hours | Every 8 hours Otitis media, sinusitis, | 45 mg/kg/day | 40 mg/kg/day lower respiratory tract | |
infections, and more | | severe infections | |

The treatment plan for Acute Sinusitis is:

• Adults: 875 mg/125 mg amoxicillin and clavulanate potassium tablet every 12 hours or 500 mg/125 mg amoxicillin and clavulanate potassium tablet every 8 hours.
• Pediatric Patients: 45 mg/kg/day every 12 hours or 40 mg/kg/day every 8 hours 2

From the Research

Treatment Plan for Acute Sinusitis

The treatment plan for acute sinusitis typically involves antibiotics and may include other medications to manage symptoms.

• The recommended duration of antibiotic therapy is typically 10 to 14 days, but some studies suggest that shorter courses of treatment may be effective 3, 4.
• The choice of antibiotic may depend on the severity of the infection and the patient's medical history, with options including amoxicillin, amoxicillin-clavulanate, cefpodoxime, and cefuroxime 3, 5.
• Topical nasal steroids may also be used to reduce inflammation and relieve symptoms, particularly in patients with less severe symptoms 6.
• The effectiveness of antibiotics and topical nasal steroids may vary depending on the individual patient and the severity of their symptoms 6.

Antibiotic Treatment Options

• Amoxicillin and amoxicillin-clavulanate are commonly used antibiotics for the treatment of acute sinusitis 3, 5, 7.
• Cefpodoxime and cefuroxime are also effective options 5.
• Short-course antibiotic treatment (up to 7 days) may be as effective as longer-course treatment (10-14 days) for uncomplicated acute bacterial sinusitis 4.

Considerations for Treatment

• The diagnosis of acute sinusitis should be confirmed with images and appropriate antibiotics should be prescribed 5.
• The optimal duration of therapy is unknown, but treatment should continue until the patient is free of symptoms and for an additional 7 days 5.
• Patients with severe symptoms or complicating factors may require longer courses of treatment 4.