Acute Rhinosinusitis Organism-Specific Therapy 

Updated: Sep 27, 2013
  • Author: Kristin Mills, DO; Chief Editor: Thomas E Herchline, MD  more...
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Specific Organisms and Therapeutic Regimens

Acute rhinosinusitis may be defined as inflammation of the nasal cavity and paranasal sinuses lasting for less than 4 weeks. It is a common ailment encountered in the outpatient setting, affecting close to 35 million people annually. [1] The estimated prevalence of viral infection during an episode of acute sinusitis is 90-98%; bacterial infection accounts for 2-10% of cases. [2, 3] In general, sinus aspiration to obtain or quantify bacterial isolates is not indicated to establish the diagnosis of acute bacterial rhinosinusitis, and antibiotics are usually not targeted against a specific organism. [3] However, if a specific pathogen is isolated and susceptibility testing is performed, organism-specific treatment is suggested as described below. [3, 4, 5]

Rhinovirus:

See the list below:

  • Supportive therapy only

Influenza:

See the list below:

Parainfluenza:

See the list below:

  • Supportive therapy only

Streptococcal pneumonia (penicillin susceptible):

S pneumonia (penicillin intermediate or resistant) *:

  • Doxycycline 100 mg PO q12h or
  • Amoxicillin-clavulanate (2 g PO q12h)* or
  • Moxifloxacin 400 mg PO q24h* or
  • Levofloxacin 500 mg PO q24h* or
  • Ceftriaxone 1-2 g IV q12-24h* or
  • Cefotaxime 2 g IV q4-6h

*Recommended regimens for patients in areas of high endemic rates of penicillin-resistant S pneumoniae, with severe infection, who attend daycare, are aged 2 years or older than 65 years, were recently hospitalized, used antibiotics within the past month, and/or are immunocompromised. IV regimens are recommended for patients with severe infection requiring hospitalization. [3]

Haemophilus influenzae:

See the list below:

  • Amoxicillin-clavulanate (875 mg/125 mg) PO q12h or
  • Doxycycline 100 mg PO q12h or
  • Moxifloxacin 400 mg PO q24h or
  • Levofloxacin 500 mg PO q24h or
  • Ceftriaxone 1-2 g IV q12-24h* or
  • Cefotaxime 2 g IV q4-6h*

*IV regimens are recommended for patients with severe infection requiring hospitalization. [3]

Moraxella catarrhalis:

See the list below:

  • Amoxicillin-clavulanate (875 mg/125 mg) PO q12h or
  • Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12h* or
  • Clarithromycin 500 mg PO q12h or extended-release 1 g PO q24h or
  • Azithromycin 500 mg in a single dose, then 250 mg PO q24h or
  • Doxycycline 100 mg PO q12h or
  • Moxifloxacin 400 mg PO q24h or
  • Levofloxacin 500 mg PO q24h

*Trimethoprim-sulfamethoxazole resistances rates of up to 50% have been reported in M catarrhalis. [4]

Staphylococcus aureus (methicillin-resistant, MRSA):

  • Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1-2 DS tablet PO q12h or
  • Clindamycin 300 mg PO q6h or
  • Doxycycline 100 mg PO q12h

Staphylococcus aureus (methicillin-susceptible, MSSA):

  • Amoxicillin-clavulanate (875 mg/125 mg) PO q12h or
  • Clindamycin 300 mg PO q6h or
  • Doxycycline 100 mg PO q12h

Anaerobic bacteria:

See the list below:

  • Amoxicillin-clavulanate (875 mg/125 mg) PO q12h or
  • Clindamycin 300 mg PO q6h

Duration of therapy

For uncomplicated acute bacterial rhinosinusitis in adults, the recommended duration is 5-7 days.

For acute bacterial rhinosinusitis in children or in cases of severe infection in adults, an extended period of 10-14 days is recommended.