Guidelines for the Diagnosis and Treatment of Acute Bacterial 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/clavulanate, 500/125 mg PO tid or 875/125 mg PO bidb Penicillin allergy: Doxycycline, 100 mg PO bid; or An antipneumococcal fluoroquinolone (e.g., moxifloxacin, 400 mg/d PO daily)c Exposure to antibiotics within 30 d or >30% prevalence of penicillin-resistant Streptococcus pneumoniae: Amoxicillin/clavulanate (extended release), 2000/125 mg PO bid; or Doxycycline, 100 mg PO bid; or An antipneumococcal fluoroquinolone (e.g., moxifloxacin, 400 mg PO daily)c Recent treatment failure: Amoxicillin/clavulanate (extended release), 2000 mg PO bid; or An antipneumococcal fluoroquinolone (e.g., moxifloxacin, 400 mg PO daily)c |
a The duration of therapy is 5-7 days if symptoms improve within the first few days of treatment but can be up to 7-10 days, with appropriate follow-up. Severe disease may warrant IV antibiotics and consideration of hospital admission.
b In areas where the prevalence of antibiotic resistance is low, amoxicillin can be considered as initial therapy in pts without recent antibiotic exposure.
cFluoroquinolones carry a risk of tendinitis and neuropathy and should be used only if other options are not reasonable, with consideration of risks and benefits.