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:

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