Specific Organisms and Therapeutic Regimens
The goal of antimicrobial therapy is to promote sinus drainage, reduce chronic inflammation, and eradicate infecting pathogens. [1] A comprehensive approach using topical or oral glucocorticoids, antibiotics, and nasal irrigation is beneficial in the treatment of chronic rhinosinusitis. [2, 3, 4, 5, 6, 7, 8, 9, 10, 11]
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. [2, 3, 4, 5, 6, 7, 12]
Streptococcus pneumoniae
Penicillin-susceptible:
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Amoxicillin 500 mg to 1 g PO q8h
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Duration of therapy: A trial of 14-28d is reasonable; longer durations (up to 6wk) may be required for refractory cases
Penicillin-resistant:
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Moxifloxacin 400 mg PO/IV daily or
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Levofloxacin 500 mg PO daily or
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Vancomycin 1 g or 15 mg/kg IV q12h
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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:
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Amoxicillin-clavulanate 500 mg PO q8h or 875 mg PO q12h or
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Moxifloxacin 400 mg PO/IV daily or
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Levofloxacin 500 mg PO daily or
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Cefuroxime 500 mg PO BID
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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):
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Amoxicillin-clavulanate 500 mg PO q8h or 875 mg PO q12h or
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Cefuroxime 500 mg PO BID or
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Dicloxacillin 250 mg PO every 6 hr
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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):
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Clindamycin 300-450 mg PO q6-8h or
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Vancomycin 1 g or 15 mg/kg IV q12h or
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Daptomycin 4 mg/kg IV once daily or
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Linezolid 600 mg IV/PO BID
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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:
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Ciprofloxacin 500-750 mg PO q12h or 400mg q8-12h IV or
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Levofloxacin 500-750 mg PO/IV daily or
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Cefepime 2 g IM/IV q12h
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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:
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Clindamycin 300-450 mg PO q6-8h or
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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