Chronic Rhinosinusitis Empiric Therapy

Updated: Feb 14, 2023
  • Author: Itzhak Brook, MD, MSc; Chief Editor: Thomas E Herchline, MD  more...
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Empiric Therapeutic Regimens

The goal of antimicrobial therapy for chronic rhinosinusitis (CRS) is to promote sinus drainage, reduce chronic inflammation, improve the quality of life, and eradicate infecting pathogens. [1, 2, 3] A comprehensive approach using topical or oral glucocorticoids, antibiotics, and nasal irrigation is beneficial in the treatment of CRS. [4, 5, 6, 7, 8, 9, 10, 11, 12]

Initial treatment of CRS is usually empiric, and selected antimicrobials should be effective against both aerobic and anaerobic pathogens, [4, 5, 6, 7, 8, 9] as follows:

  • Amoxicillin-clavulanate 500 mg PO q8h or 875 mg PO q12h

  • Penicillin-allergic or methicillin-resistant Staphylococcus aureus (MRSA): Clindamycin 300 mg PO q6h or 450 mg q8h; metronidazole 250-500mg q8h plus azithromycin 500 mg PO on day 1, followed by 250 mg qd on days 2 to 5; clarithromycin 500 mg PO q12h;  or moxifloxacin 400 mg PO/IV daily

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