Guidelines for the Diagnosis and Treatment of Acute Sinusitis in Adults
| Diagnostic Criteria | Treatment Recommendationsa |
|---|---|
Moderate symptoms (e.g., nasal purulence/congestion or cough) for >10 d or Severe symptoms of any duration, including unilateral/focal facial swelling or tooth pain | Initial therapy: Amoxicillin, 500 mg PO tid; or Amoxicillin/clavulanate, 500/125 mg PO tid or 875/125 mg PO bidb Penicillin allergy: Doxycycline, 100 mg PO bid; or Clindamycin, 300 mg PO tid Exposure to antibiotics within 30 d or >30% prevalence of penicillin-resistant Streptococcus pneumoniae: Amoxicillin/clavulanate (extended release), 2000/125 mg PO bid; or An antipneumococcal fluoroquinolone (e.g., moxifloxacin, 400 mg PO daily) Recent treatment failure: Amoxicillin/clavulanate (extended release), 2000 mg PO bid; or An antipneumococcal fluoroquinolone (e.g., moxifloxacin, 400 mg PO daily) |
aThe duration of therapy is generally 7-10 days (with consideration of a 5-day course), with appropriate follow-up. Severe disease may warrant IV antibiotics and consideration of hospital admission.
bAlthough the evidence is not as strong, amoxicillin/clavulanate may be considered for initial use, particularly if local rates of penicillin resistance or β-lactamase production are high.