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. [4, 5, 3] However, if a specific pathogen is isolated and susceptibility testing is performed, organism-specific treatment is suggested as described below. [3, 6, 7]
Rhinovirus:
See the list below:
-
Supportive therapy only
Influenza:
See the list below:
-
Oseltamivir 75 mg PO q12h for 5d
Parainfluenza:
See the list below:
-
Supportive therapy only
Streptococcal pneumonia (penicillin susceptible):
-
Amoxicillin 500 mg PO q8h or
-
Amoxicillin-clavulanate (875 mg/125 mg) PO q12h or
-
Doxycycline 100 mg PO q12h
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. [6]
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. [8]