From the Guidelines
Antibiotic of Choice for Acute Sinusitis
The recommended antibiotic of choice for acute sinusitis is amoxicillin-clavulanate, with a dosage of 875mg/125mg orally twice daily for 5-7 days in patients with mild disease, or 7-10 days in patients with moderate to severe disease 1.
Alternative Options
Alternatively, doxycycline 100mg orally twice daily for 5-7 days or levofloxacin 500mg orally once daily for 5-7 days may be considered in patients with penicillin allergy or resistance 1. Azithromycin 500mg orally once daily for 3 days is also an option, although its use is generally reserved for patients with mild disease.
Special Considerations
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.
Key Points
- Amoxicillin-clavulanate is the preferred agent for acute bacterial sinusitis due to its effectiveness, safety, and relatively narrow microbiologic spectrum 1.
- The duration of antibiotic therapy should be individualized, with a minimum course of 10 days, and should be continued for 7 days after the patient becomes free of signs and symptoms 1.
- Adjunctive therapy, such as intranasal saline irrigation or intranasal corticosteroids, may be used to alleviate symptoms and potentially decrease antibiotic use 1.
From the FDA Drug Label
- 4 Acute Bacterial Sinusitis: 5 Day and 10 to 14 Day Treatment Regimens 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)].
The antibiotic of choice for acute sinusitis is levofloxacin 2.
- Approved pathogens:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
- Treatment regimens:
- 750 mg by mouth x 5 days
- 500 mg by mouth once daily x 10 to 14 days
From the Research
Antibiotic Treatment for Acute Sinusitis
The choice of antibiotic for acute sinusitis is a crucial aspect of treatment. Based on the available evidence, the following points can be considered:
- Amoxicillin plus clavulanate is a commonly recommended antibiotic for acute bacterial sinusitis 3, 4, 5.
- The dosage of amoxicillin plus clavulanate can vary, with some studies suggesting that a high-dose regimen (875 mg/125 mg) may be effective 3, 5.
- Comparative studies have shown that amoxicillin plus clavulanate is as effective as other antibiotics, such as clarithromycin, in treating community-acquired pneumonia and acute bacterial maxillary sinusitis 4, 6.
- However, it is essential to note that amoxicillin can exacerbate myasthenia gravis in some patients, and close monitoring is recommended 7.
Key Findings
- A randomized clinical trial found that high-dose amoxicillin plus clavulanate (875 mg/125 mg) did not provide significant benefits over standard-dose amoxicillin plus clavulanate in adults with acute sinusitis 3.
- A multicenter double-blind randomized double-dummy controlled trial demonstrated that amoxicillin plus clavulanate given every 12 hours is as effective and safe as administration every 8 hours for the treatment of acute bacterial maxillary sinusitis 4.
- A review of co-amoxiclav (875 mg/125 mg) highlights its effectiveness in treating various infections, including acute bacterial maxillary sinusitis, and its safety profile 5.