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Air-fluid level (arrow) in the maxillary sinus suggests sinusitis.

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Table 1. Dosage, Route, and Spectrum of Activity of Commonly Used First-Line Antibiotics*

Antibiotic	Dosage	Streptococcus pneumoniae			Haemophilus influenzae	Moraxella catarrhalis	Anaerobic bacteria
Antibiotic	Dosage	Sensitive	Intermediate	Resistant	Haemophilus influenzae	Moraxella catarrhalis	Anaerobic bacteria
Amoxicillin	500 mg PO tid	+++	++	+	++	+	+
Clarithromycin	250-500 mg PO bid	++	++	+	++	+++	+
Azithromycin	500 mg PO first day, then 250 mg/d PO for 4 days	++	++	+	++	+++	+

Table 2. Dosage, Route, and Spectrum of Activity of Commonly Used Second-Line Antibiotics*

Antibiotic	Dosage	Streptococcus pneumoniae			Haemophilus influenzae	Moraxella catarrhalis	Anaerobic bacteria
Antibiotic	Dosage	Sensitive	Intermediate	Resistant	Haemophilus influenzae	Moraxella catarrhalis	Anaerobic bacteria
Amoxicillin/clavulanate	500 mg PO tid	+++	++	+	+++	+++	+++
Cefuroxime	250-500 mg PO bid	+++	++	+	+++	++	++
Cefpodoxime + cefixime	200 mg PO bid 400 mg/d PO	- ++	+++ -	++ -	+ +++	+++ +++	+++ -
Ciprofloxacin	500-750 mg PO bid	++	+	+	++	+++	+
Levofloxacin	500 mg/d PO	+++	+++	+++	+++	+++	+++
Trovafloxacin	200 mg/d PO	+++	+++	+++	+++	+++	+++
Clindamycin	300 mg PO tid	+++	+++	+++	-	-	+++
Metronidazole	500 mg PO tid	-	-	-	-	-	+++

Table 3. Dosage, Route, and Spectrum of Activity of Commonly Used Intravenous Antibiotics*

Antibiotic	Dosage	*Streptococcus pneumoniae*	*Haemophilus influenzae*	*Moraxella catarrhalis*	Gram-negative	Anaerobic bacteria
Piperacillin	3-4 g IV q4-6h	+++	+	-	+++	+++
Piperacillin/tazobactam	3.375 g IV q6h	+++	+++	+++	+++	++
Ticarcillin	3 g IV q4h	+++	-	-	+++	++
Ticarcillin/clavulanate	3.1 g IV q4h	+++	+++	-	+++	++
Imipenem	500 mg IV q6h	+++	+++	+++	+++	+++
Meropenem	1 g IV q8h	+++	+++	+++	+++	++
Cefuroxime	1 g IV q8h	+++	+++	+++	++	++
Ceftriaxone	2 g IV bid	+++	+++	+++	+++	++
Cefotaxime	2 g IV q4-6h	+++	+++	+++	+++	++
Ceftazidime	2 g IV q8h	+++	+++	+++	+++	++
Gentamicin	1.7 mg/kg IV q8h	-	+++	+++	++	-
Tobramycin	1.7 mg/kg IV q8h	-	+++	+++	++	-
Vancomycin	1 g IV q6-12h	+++	-	-	-	++

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Author

Ted L Tewfik, MD Professor of Otolaryngology-Head and Neck Surgery, Professor of Pediatric Surgery, McGill University Faculty of Medicine; Senior Staff, Montreal Children's Hospital, Montreal General Hospital, and Royal Victoria Hospital

Ted L Tewfik, MD is a member of the following medical societies: American Society of Pediatric Otolaryngology, Canadian Society of Otolaryngology-Head & Neck Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Stephen G Batuello, MD Consulting Staff, Colorado ENT Specialists

Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Association for Physician Leadership, American Medical Association, Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

Jack A Coleman, MD Consulting Staff, Franklin Surgical Associates

Jack A Coleman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Sleep Medicine, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Bronchoesophagological Association, American College of Surgeons, The Triological Society, American Society for Laser Medicine and Surgery, The Society of Federal Health Professionals (AMSUS)

Disclosure: Received honoraria from Accarent, Inc. for speaking and teaching.

Acknowledgements

Melvin D Schloss, MD, FRCSC, Director of Pediatric Otolaryngology, Professor, Department of Otolaryngology, McGill University Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Steven E Sobol, MD, FRCSC, MSc, FAAP Assistant Professor, Director of Pediatric Otolaryngology, Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine; Otolaryngologist-In-Chief, Children's Healthcare of Atlanta at Egleston

Steven E Sobol, MD, FRCSC, MSc, FAAP is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

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