Chronic Rhinosinusitis Organism-Specific Therapy 

Updated: Oct 27, 2015
  • Author: Itzhak Brook, MD, MSc; Chief Editor: Thomas E Herchline, MD  more...
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Specific Organisms and Therapeutic Regimens

The goal of antimicrobial therapy is to promote sinus drainage, reduce chronic inflammation, and eradicate infecting pathogens. A comprehensive approach using topical or oral glucocorticoids, antibiotics, and nasal irrigation is beneficial in the treatment of chronic rhinosinusitis. [1, 2, 3, 4, 5, 6, 7, 8, 9]

Organism-specific therapeutic regimens for chronic rhinosinusitis are outlined below, including those for Streptococcus pneumoniae, Haemophilus influenzae and/or Moraxella catarrhalis, Staphylococcus aureus, Pseudomonas aeruginosa, and anaerobic gram-negative bacilli. [1, 2, 3, 4, 5, 6]

Streptococcus pneumoniae

Penicillin-susceptible:

  • Amoxicillin 500 mg to 1 g PO q8h
  • Duration of therapy: A trial of 14-28d is reasonable; longer durations (up to 6wk) may be required for refractory cases

Penicillin-resistant:

  • Moxifloxacin 400 mg PO/IV daily or
  • Levofloxacin 500 mg PO daily or
  • Vancomycin 1 g or 15 mg/kg IV q12h
  • Duration of therapy: A trial of 14-28d is reasonable; longer durations (up to 6wk) may be required for refractory cases

Haemophilus influenzae and/or Moraxella catarrhalis

See the list below:

  • Amoxicillin-clavulanate 500 mg PO q8h or 875 mg PO q12h or
  • Moxifloxacin 400 mg PO/IV daily or
  • Levofloxacin 500 mg PO daily or
  • Cefuroxime 500 mg PO BID
  • Duration of therapy: A trial of 14-28d is reasonable; longer durations (up to 6wk) may be required for refractory cases

Staphylococcus aureus

Methicillin-sensitive S aureus (MSSA):

  • Amoxicillin-clavulanate 500 mg PO q8h or 875 mg PO q12h or
  • Cefuroxime 500 mg PO BID or
  • Dicloxacillin 250 mg PO every 6 hr
  • Duration of therapy: A trial of 14-28d is reasonable; longer durations (up to 6wk) may be required for refractory cases

Methicillin-resistant S aureus (MRSA):

  • Clindamycin 300-450 mg PO q6-8h or
  • Vancomycin 1 g or 15 mg/kg IV q12h or
  • Daptomycin 4 mg/kg IV once daily or
  • Linezolid 600 mg IV/PO BID
  • Duration of therapy: A trial of 14-28d is reasonable; longer durations (up to 6wk) may be required for refractory cases

Pseudomonas aeruginosa

See the list below:

  • Ciprofloxacin 500-750 mg PO q12h or 400mg q8-12h IV or
  • Levofloxacin 500-750 mg PO/IV daily or
  • Cefepime 2 g IM/IV q12h
  • Duration of therapy: A trial of 14-28d is reasonable; longer durations (up to 6wk) may be required for refractory cases

Anaerobic gram-negative bacilli

See the list below:

  • Clindamycin 300-450 mg PO q6-8h or
  • Moxifloxacin 400 mg PO daily or
  • Amoxicillin-clavulanate 500 mg PO q8h or 875 mg PO q12h
  • Duration of therapy: A trial of 14-28d is reasonable; longer durations (up to 6wk) may be required for refractory cases