antibiotic sinus infection penicillin allergy Azithromycin for sinusitis

Best antibiotic for sinus infection with penicillin allergy

Patients with painful sinus problems often plead with their doctors to give them an antibiotic ASAP.

About 90% of adults seen in the U.S. by a general practice physician do end up getting an antibiotic for acute sinusitis, research has found.

Acute sinusitis is a sinus infection that lasts less than four weeks. Chronic sinusitis lasts longer than 12 weeks. Infections of the sinuses, hollow air spaces within the bones in the cheek bones, forehead and between the eyes, are usually caused by viral or bacterial infections. They cause thick mucus blockage and discomfort of the cavities.

But antibiotics may not always be the best remedy for sinusitis, according to recent research and physician experts. Your body should be able to cure itself of a mild or moderate sinusitis and avoid antibiotics that can cause antibiotic resistance.

Judicious use of antibiotics is now recommended by many agencies that have published guidelines, including practice guidelines issued jointly by the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology.

Research into Antibiotics and Sinus Infections

The guidelines were triggered, in part, by studies finding that antibiotics may not make a difference. About 60% to 70% of people with sinus infections recover without antibiotics, according to the American Academy of Allergy, Asthma & Immunology.

In one study of symptom relief, patients given antibiotics generally did no better than patients not given antibiotics.

This study, published in the Journal of the American Medical Association, observed 240 patients with sinusitis. They were given one of four treatments: antibiotics alone, nasal steroid spray alone to reduce tissue swelling, both antibiotics and the spray, or no treatment.

Patients who got no treatment were as likely to get better than those who got the antibiotics. The nasal spray seemed to help people with less severe symptoms at the beginning of their sinus problem, and seemed to make those with more intense congestion worse.

The patients all had sinus symptoms that suggested a bacterial infection. Sinus problems are also caused by viruses, for which antibiotics definitely offer no help.

Is Your Sinus Infection Caused by a Virus or Bacteria?

Physicians may not know if sinusitis is bacterial or viral, because the diagnosis is typically done by observing symptoms. Symptoms include:

  • Nasal congestion
  • Pain or discomfort around the eyes, forehead or cheeks
  • Cough
  • Headache
  • Thick nasal or post-nasal drainage

Sometimes other tests such as computed tomography (CT) scan or cultures are used to help make the diagnosis.

Despite the recommendations that antibiotic use be judicious, they are still overused for sinusitis, according to many physicians who specialize in treating sinus problems.

Some physicians say they give patients with sinusitis a prescription for antibiotics, and recommend they wait three to five days before filling it, and only fill it if symptoms are not better by then. A decongestant can be used to help relieve your symptoms and promote drainage.

The longer symptoms last, the more likely a sinus problem is to be a bacterial infection, some experts say.

When Antibiotics Are Appropriate Treatment

Antibiotics may be given to people who are less able to fight off infection, such as those with diabetes, or serious heart or lung disease.

In addition, antibiotics can be given to those whose symptoms have gotten worse or those who show no improvement after seven days.

If antibiotics are given, a 10- to 14-day course is recommended, according to the practice guidelines. Amoxicillin (Amoxil) or amoxicillin clavulanate (Augmentin) are typically the first choice for people who are not allergic to penicillin.

Stop paying too much for your prescriptions

Thanks for visiting! GoodRx is not available outside of the United States. If you are trying to access this site from the United States and believe you have received this message in error, please reach out to and let us know.

Medication Summary

Viral rhinosinusitis does not require antimicrobial treatment. Standard nonantimicrobial treatment options include topical steroids, topical and/or oral decongestants, mucolytics, and intranasal saline spray.

Antimicrobial therapy is the mainstay of medical treatment in sinusitis. The choice of antibiotics depends on whether the sinusitis is acute, chronic, or recurrent.

Antibiotic efficacy rates are as follows [54] :

  • Levofloxacin, moxifloxacin, and amoxicillin/clavulanate - Greater than 90%

  • High-dose amoxicillin, cefpodoxime proxetil, cefixime, cefuroxime axetil, and trimethoprim-sulfamethoxazole - 80-90%

  • Clindamycin, doxycycline, cefprozil, azithromycin, clarithromycin, and erythromycin - 70-80%

  • Cefaclor - 50-60%

On the basis of the 2000 Sinus and Allergy Health Partnership treatment guidelines for acute bacterial rhinosinusitis, patients are divided into 3 groups, as follows:

  • Adults with mild disease who have not received antibiotics: Amoxicillin/clavulanate, amoxicillin (1.5-3.5 g/day), cefpodoxime proxetil, or cefuroxime is recommended as initial therapy.

  • Adults with mild disease who have had antibiotics in the previous 4-6 weeks and adults with moderate disease: Amoxicillin/clavulanate, amoxicillin (3-3.5 g), cefpodoxime proxetil, or cefixime is recommended.

  • Adults with moderate disease who have received antibiotics in the previous 4-6 weeks: Amoxicillin/clavulanate, levofloxacin, moxifloxacin, or doxycycline is recommended.

Patients who remain symptomatic despite appropriate antibiotic therapy may be evaluated with sinus endoscopy, CT scanning, or sinus aspiration/culture.

Penicillins

Class Summary

The penicillins are bactericidal antibiotics that work against sensitive organisms at adequate concentrations and inhibit the biosynthesis of cell wall mucopeptide. The penicillins are also available in combination with agents that inactivate beta-lactamase enzymes, extending their antibiotic spectrum.

Piperacillin and Tazobactam sodium (Zosyn)

  • View full drug information

The piperacillin-tazobactam combination includes an antipseudomonal penicillin plus beta-lactamase inhibitor. It inhibits biosynthesis of cell wall mucopeptide and is effective during the stage of active multiplication.

Ticarcillin and clavulanate potassium

  • View full drug information

The ticarcillin-clavulanate combination inhibits the biosynthesis of cell wall mucopeptide and is effective during the stage of active growth. It has antipseudomonal penicillin plus a beta-lactamase inhibitor that provides coverage against most gram-positive, gram-negative, and anaerobic organisms.

Penicillin VK

  • View full drug information

Penicillin V potassium is a first-line antibiotic choice. It inhibits biosynthesis of cell wall mucopeptide. It is bactericidal against sensitive organisms when adequate concentrations are reached and most effective during the stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.

Amoxicillin and clavulanate (Augmentin, Amoclan)

  • View full drug information

Amoxicillin-clavulanate is a second-line agent; this drug combination treats bacteria resistant to beta-lactam antibiotics.

Amoxicillin (Moxatag)

  • View full drug information

Amoxicillin is a first-line antibiotic choice. It interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria.

Piperacillin

  • View full drug information

Piperacillin inhibits the biosynthesis of cell wall mucopeptides and the stage of active multiplication; it has antipseudomonal activity.

Cephalosporins

Class Summary

Cephalosporins are structurally and pharmacologically related to penicillins. They inhibit bacterial cell wall synthesis, resulting in bactericidal activity. Cephalosporins are divided into first, second, third and fourth generation. First-generation cephalosporins have greater activity against gram-positive bacteria, and succeeding generations have increased activity against gram-negative bacteria and decreased activity against gram-positive bacteria.

Cefprozil

  • View full drug information

Cefprozil is a second-line agent. It binds to one or more of the penicillin-binding proteins, which, in turn, inhibits cell wall synthesis and results in bactericidal activity.

Cefuroxime (Ceftin, Zinacef)

  • View full drug information

Cefuroxime is a second-line agent. It is a second-generation cephalosporin that maintains the gram-positive activity of first-generation cephalosporins, adding activity against Proteus mirabilis, H influenzae, Escherichia coli, Klebsiella pneumoniae, and M catarrhalis.

Cefpodoxime

  • View full drug information

Cefpodoxime is a second-line agent. It binds to one or more penicillin-binding proteins, which, in turn, inhibits cell wall synthesis and results in bactericidal activity.

Cefixime (Suprax)

  • View full drug information

Cefixime is a second-line agent. By binding to one or more penicillin-binding proteins, it arrests bacterial cell wall synthesis and inhibits bacterial growth.

Ceftriaxone (Rocephin)

  • View full drug information

Ceftriaxone is a third-generation cephalosporin with broad-spectrum, gram-negative activity; it has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. It arrests bacterial growth by binding to one or more penicillin binding proteins. It has good penetration.

Cefdinir

  • View full drug information

Classified as a third-generation cephalosporin, cefdinir inhibits mucopeptide synthesis in the bacterial cell wall. It is typically bactericidal, depending on organism susceptibility, dose, and serum or tissue concentrations.

Cefaclor

  • View full drug information

Cefaclor is used for treatment of infections caused by susceptible organisms including H influenzae and for treatment of otitis media, sinusitis, and infections involving the respiratory tract. It may not be appropriate in acute sinusitis, owing to less activity and the potential for severe allergic reactions.

Cefotaxime (Claforan)

  • View full drug information

Cefotaxime is a third-generation cephalosporin with broad gram-negative spectrum, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. It arrests bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins, which, in turn, inhibits bacterial growth.

Ceftazidime (Fortaz, Tazicef)

  • View full drug information

Ceftazidime is a third-generation cephalosporin with broad-spectrum, gram-negative activity, including pseudomonas; lower efficacy against gram-positive organisms; and higher efficacy against resistant organisms. It arrests bacterial growth by binding to one or more penicillin-binding proteins, which, in turn, inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall synthesis, thus inhibiting cell wall biosynthesis.

Macrolides

Class Summary

Macrolide antibiotics have bacteriostatic activity and exert their antibacterial action by binding to the 50S ribosomal subunit of susceptible organisms, resulting in inhibition of protein synthesis. Macrolide antibiotics are often used in patients allergic to penicillins.

Erythromycin ethylsuccinate (E.E.S., Ery-Tab, PCE)

  • View full drug information

Erythromycin is a first-line treatment in patients allergic to penicillin. It inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Clarithromycin (Biaxin)

  • View full drug information

Clarithromycin is a second-line agent. It inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Azithromycin (Zithromax, Zmax)

  • View full drug information

Azithromycin, an advanced-generation macrolide, works similarly to clarithromycin but with shorter dosage time.

Erythromycin base and sulfisoxazole (Pediazole)

  • View full drug information

This agent is used for treatment of susceptible bacterial infections of upper and lower respiratory tract: in children, it is used for otitis media caused by susceptible strains of H influenzae; it is used for many other infections in patients allergic to penicillin.

Fluoroquinolones

Class Summary

Fluoroquinolones have broad-spectrum activity against gram-positive and gram-negative aerobic organisms. They inhibit DNA synthesis and growth by inhibiting DNA gyrase and topoisomerase, which is required for replication, transcription, and translation of genetic material.

Levofloxacin (Levaquin)

  • View full drug information

Levofloxacin is used to treat acute maxillary sinusitis caused by S pneumoniae, H influenzae, or M catarrhalis. Fluoroquinolones should be used empirically in patients likely to develop exacerbation due to resistant organisms to other antibiotics. This is the L stereoisomer of the D/L parent compound ofloxacin, the D form being inactive. It provides good monotherapy with extended coverage against Pseudomonas species, as well as excellent activity against pneumococcus. The agent acts by inhibition of DNA gyrase activity. The oral form has bioavailability that is reportedly 99%.

Ciprofloxacin (Cipro)

  • View full drug information

Ciprofloxacin is a broad spectrum antibiotic with activity against gram-positive and gram-negative aerobic organisms. It inhibits bacterial DNA synthesis and, consequently, growth, by inhibiting DNA gyrase and topoisomerase, which are required for replication, transcription, and translation of genetic material.

Moxifloxacin (Avelox)

  • View full drug information

Moxifloxacin inhibits the A subunits of DNA gyrase, resulting in inhibition of bacterial DNA replication and transcription.

Anti-Infectives

Class Summary

Anti-infectives such as vancomycin, clindamycin, metronidazole, and sulfamethoxazole-trimethoprim are effective against some types of bacteria that have become resistant to other antibiotics.

Trimethoprim and sulfamethoxazole (Bactrim, Bactrim DS, Sulfatrim Pediatric)

  • View full drug information

Trimethoprim-sulfamethoxazole is a first-line agent with more convenient dosing. It inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid.

Vancomycin

  • View full drug information

Vancomycin is a potent antibiotic directed against gram-positive organisms and active against Enterococcus species (useful in septicemia and skin structure infections; Enterococcus is very rare in sinusitis). Vancomycin is indicated for patients who cannot receive or have failed to respond to penicillins and cephalosporins or who have infections with resistant staphylococci.

Metronidazole (Flagyl, Metro)

  • View full drug information

Metronidazole is an imidazole ring-based antibiotic that is active against various anaerobic bacteria and protozoa. It is used in combination with other antimicrobial agents (except C difficile enterocolitis).

Clindamycin (Cleocin)

  • View full drug information

Clindamycin is a semisynthetic antibiotic produced by 7(S)-chloro-substitution of 7(R)-hydroxyl group of parent compound lincomycin. It inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Clindamycin widely distributes in the body without penetration of the CNS. It is protein bound and is excreted by the liver and kidneys.

Carbapenems

Class Summary

Carbapenems are structurally related to penicillins and have broad-spectrum bactericidal activity. The carbapenems exert their effect by inhibiting cell wall synthesis, which leads to cell death. They are active against gram-negative, gram-positive, and anaerobic organisms.

Imipenem and cilastatin (Primaxin)

  • View full drug information

The imipenem-cilastin combination is used for the treatment of multiple-organism infections in which other agents do not have wide-spectrum coverage or are contraindicated because of the potential for toxicity.

Meropenem (Merrem)

  • View full drug information

A bactericidal broad-spectrum carbapenem antibiotic that inhibits cell-wall synthesis, meropenem is effective against most gram-positive and gram-negative bacteria. Compared with imipenem, meropenem has slightly increased activity against gram-negative organisms and slightly decreased activity against staphylococci and streptococci.

Aminoglycosides

Class Summary

Aminoglycosides are bactericidal antibiotics used to primarily treat gram-negative infections. They interfere with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits.

Gentamicin

  • View full drug information

Gentamicin is an aminoglycoside antibiotic effective against Pseudomonas aeruginosa; E coli; and Proteus, Klebsiella, and Staphylococcus species. Gentamicin is also variably effective against some strains of certain gram-positive organisms, including S aureus, enterococci, and L monocytogenes. Dosing regimens are numerous; adjust the dose based on creatinine clearance and changes in volume of distribution.

Tobramycin

  • View full drug information

Tobramycin is used in skin, bone, and skin structure infections caused by S aureus, P aeruginosa, Proteus species, E coli, Klebsiella species, and Enterobacter species. It is indicated in the treatment of staphylococcal infections when penicillin or potentially less-toxic drugs are contraindicated and when bacterial susceptibility and clinical judgment justify its use. Like other aminoglycosides, tobramycin is associated with nephrotoxicity and ototoxicity.

Tetracyclines

Class Summary

Tetracyclines inhibit protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. They may block dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Doxycycline (Doryx, Adoxa, Monodox, Vibramycin)

  • View full drug information

Doxycycline has broad-spectrum activity and is a synthetically derived bacteriostatic antibiotic in the tetracycline class. Doxycycline inhibits protein synthesis, and thus bacterial growth, by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Decongestants

Class Summary

These agents cause vasoconstriction, which reduces nasal congestion. Topical agents are locally active vasoconstrictor agents such as phenylephrine and oxymetazoline, which provide immediate symptomatic relief by shrinking the inflamed and swollen nasal mucosa. Oral decongestants such as pseudoephedrine can be used for 10-14 days to allow for restoration of normal mucociliary function and drainage.

Phenylephrine nasal (Neo-Synephrine Cold & Sinus, Rhinall, Nasal Four)

  • View full drug information

Phenylephrine produces vasoconstriction. It is possibly helpful and is not harmful.

Oxymetazoline (Afrin 12 Hour, Afrin Sinus, QlearQuil)

  • View full drug information

Oxymetazoline is applied directly to mucous membranes. It stimulates alpha-adrenergic receptors and causes vasoconstriction. Decongestion occurs without drastic changes in blood pressure, vascular redistribution, or cardiac stimulation.

Tetrahydrozoline, ophthalmic (Tyzine)

  • View full drug information

The alpha-adrenergic effects of tetrahydrozoline on nasal mucosa produce vasoconstriction.

Pseudoephedrine (Sudafed, Nexafed, SudoGest, Genaphed)

  • View full drug information

Phenylephrine produces vasoconstriction. It is possibly helpful and is not harmful.

Nasal Sprays

Class Summary

Nasal saline spray and steam inhalation help by moistening dry secretions, reducing mucosal edema, and reducing mucus viscosity. The symptomatic relief gained in some patients can be substantial; moreover, these are benign modalities of therapy.

Saline nasal spray (Ayr, Ocean Nasal Spray, Nasal Moist)

  • View full drug information

Saline nasal sprays loosen mucus secretions to help remove mucus from the nose and sinuses.

Expectorants

Class Summary

Mucolytic agents such as guaifenesin have the theoretical benefit of thinning mucous secretions and improving drainage.

Guaifenesin (Altarussin, Bidex, Geri-Tussin, Liquibid, Mucinex)

  • View full drug information

Guaifenesin increases respiratory tract fluid secretions and helps to loosen phlegm and bronchial secretions. It is indicated for patients with bronchiectasis complicated by tenacious mucous and/or mucous plugs.

Corticosteroids

Class Summary

Intranasal steroids have not been conclusively shown to be of benefit in cases of acute sinusitis. Study results conflict, with some reporting benefit as monotherapy or in combination with antibiotics and others reporting no benefit (combination or monotherapy).

Beclomethasone, intranasal (Beconase AQ, QNASL)

  • View full drug information

Beclomethasone has potent vasoconstrictive and anti-inflammatory activity. It has a weak hypothalamic-pituitary-adrenocortical (HPA) axis inhibitory potency when applied topically.

Triamcinolone inhaled (Nasacort, Nasacort AQ)

  • View full drug information

Triamcinolone decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability.

Flunisolide intranasal

  • View full drug information

Flunisolide inhibits bronchoconstriction mechanisms, producing direct smooth muscle relaxation. It may decrease the number and activity of inflammatory cells, in turn decreasing airway hyperresponsiveness. Flunisolide decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. It does not depress the hypothalamus.

Anticholinergics

Class Summary

Anticholinergics block interactions between acetylcholine and muscarinic receptors on the smooth muscle preventing increases in cyclic GMP inhibiting bronchoconstriction and mucus secretion.

Ipratropium (Atrovent)

  • View full drug information

Topical ipratropium bromide can be used to decrease rhinorrhea. Anticholinergics such as ipratropium have anti-secretory properties, and when applied locally, inhibit secretions from serous, and seromucous glands lining the nasal mucosa.

  1. Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: National Health Interview Survey, 2012. Vital Health Stat 10. 2014, february. 1-161. [QxMD MEDLINE Link].

  2. Slavin RG, Spector SL, Bernstein IL, Kaliner MA, Kennedy DW, Virant FS, et al. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol. 2005 Dec. 116(6 Suppl):S13-47. [QxMD MEDLINE Link]. [Full Text].

  3. Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM, et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013 Jul. 132:e262-80. [QxMD MEDLINE Link]. [Full Text].

  4. Lanza DC, Kennedy DW. Adult rhinosinusitis defined. Otolaryngol Head Neck Surg. 1997 Sep. 117(3 Pt 2):S1-7. [QxMD MEDLINE Link].

  5. American Academy of Pediatrics - Subcommittee on Management of Sinusitis and Committee on Quality Management. Clinical practice guideline: management of sinusitis. Pediatrics. 2001 Sep. 108(3):798-808. [QxMD MEDLINE Link].

  6. Meltzer EO, Hamilos DL, Hadley JA, et al. Rhinosinusitis: Establishing definitions for clinical research and patient care. Otolaryngol Head Neck Surg. 2004 Dec. 131(6 Suppl):S1-62. [QxMD MEDLINE Link].

  7. Stark JM, Colasurdo GN. Lung Defense: intrinsic, innate and adaptive. Chernick V, Boat TF, Wilmott RW, Bush A, eds. Kendig's Disorders of the Respiratory Tract in Children. 7th Ed. Philadelphia, PA: Saunders Elsevier; 2006. Vol. 12: 206.

  8. Wald ER, DeMuri,. Sinusitis. Long SS, Prober CG, Fischer M, eds. Principles and Practice of pediatric infectious disease. 5th ed. Philadelphia, PA: Elsevier; 2018. 230-234.

  9. Brook I. Aerobic and anaerobic bacterial flora of normal maxillary sinuses. Laryngoscope. 1981 Mar. 91(3):372-6. [QxMD MEDLINE Link].

  10. Su WY, Liu C, Hung SY, Tsai WF. Bacteriological study in chronic maxillary sinusitis. Laryngoscope. 1983 Jul. 93(7):931-4. [QxMD MEDLINE Link].

  11. Sobin J, Engquist S, Nord CE. Bacteriology of the maxillary sinus in healthy volunteers. Scand J Infect Dis. 1992. 24(5):633-5. [QxMD MEDLINE Link].

  12. Jiang RS, Liang KL, Jang JW, Hsu CY. Bacteriology of endoscopically normal maxillary sinuses. J Laryngol Otol. 1999 Sep. 113(9):825-8. [QxMD MEDLINE Link].

  13. Gordts F, Halewyck S, Pierard D, Kaufman L, Clement PA. Microbiology of the middle meatus: a comparison between normal adults and children. J Laryngol Otol. 2000 Mar. 114(3):184-8. [QxMD MEDLINE Link].

  14. Hamilos DL. Clinical manifestations, pathophysiology, and diagnosis of chronic rhinosinusitis. UpToDate. Available at //www.uptodate.com. Accessed: June 7th, 2009.

  15. Ah-See K. Sinusitis (acute). Clin Evid (Online). 2008 Mar 10. 2008:[QxMD MEDLINE Link].

  16. Hwang PH, Getz A. Acute sinusitis and rhinosinusitis in adults. UpToDate. Available at //www.uptodate.com. Accessed: June 7th, 2009.

  17. Revai K, Dobbs LA, Nair S, Patel JA, Grady JJ, Chonmaitree T. Incidence of acute otitis media and sinusitis complicating upper respiratory tract infection: the effect of age. Pediatrics. 2007 Jun. 119(6):e1408-12. [QxMD MEDLINE Link].

  18. Gwaltney JM Jr. Acute community-acquired sinusitis. Clin Infect Dis. 1996 Dec. 23(6):1209-23; quiz 1224-5. [QxMD MEDLINE Link].

  19. Brook I, Foote PA, Hausfeld JN. Frequency of recovery of pathogens causing acute maxillary sinusitis in adults before and after introduction of vaccination of children with the 7-valent pneumococcal vaccine. J Med Microbiol. 2006 Jul. 55:943-6. [QxMD MEDLINE Link].

  20. Brook I, Gober AE. Frequency of recovery of pathogens from the nasopharynx of children with acute maxillary sinusitis before and after the introduction of vaccination with the 7-valent pneumococcal vaccine. Int J Pediatr Otorhinolaryngol. 2007 Apr. 71(4):575-9. [QxMD MEDLINE Link].

  21. Jacobs MR, Bajaksouzian S, Windau A, Good CE, Lin G, Pankuch GA, et al. Susceptibility of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis to 17 oral antimicrobial agents based on pharmacodynamic parameters: 1998-2001 U S Surveillance Study. Clin Lab Med. 2004 Jun. 24(2):503-30. [QxMD MEDLINE Link].

  22. Payne SC, Benninger MS. Staphylococcus aureus is a major pathogen in acute bacterial rhinosinusitis: a meta-analysis. Clin Infect Dis. 2007 Nov 15. 45(10):e121-7. [QxMD MEDLINE Link].

  23. Brook I, Foote PA, Hausfeld JN. Increase in the frequency of recovery of meticillin-resistant Staphylococcus aureus in acute and chronic maxillary sinusitis. J Med Microbiol. 2008 Aug. 57:1015-7. [QxMD MEDLINE Link].

  24. Bishai WR. Issues in the management of bacterial sinusitis. Otolaryngol Head Neck Surg. 2002 Dec. 127(6 Suppl):S3-9. [QxMD MEDLINE Link].

  25. Ray NF, Baraniuk JN, Thamer M, Rinehart CS, Gergen PJ, Kaliner M, et al. Healthcare expenditures for sinusitis in 1996: contributions of asthma, rhinitis, and other airway disorders. J Allergy Clin Immunol. 1999 Mar. 103(3 Pt 1):408-14. [QxMD MEDLINE Link].

  26. Fendrick AM, Saint S, Brook I, Jacobs MR, Pelton S, Sethi S. Diagnosis and treatment of upper respiratory tract infections in the primary care setting. Clin Ther. 2001 Oct. 23(10):1683-706. [QxMD MEDLINE Link].

  27. Wald ER, Guerra N, Byers C. Upper respiratory tract infections in young children: duration of and frequency of complications. Pediatrics. 1991 Feb. 87(2):129-33. [QxMD MEDLINE Link].

  28. Gwaltney JM Jr, Hendley JO, Simon G, Jordan WS Jr. Rhinovirus infections in an industrial population. II. Characteristics of illness and antibody response. JAMA. 1967 Nov 6. 202(6):494-500. [QxMD MEDLINE Link].

  29. [Guideline] Richard M Rosenfeld , David Andes, Neil Bhattacharyya, Dickson Cheung, Steven Eisenberg, Theodore G Ganiats, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007 Sep. 137(3 Suppl):S1-31. [QxMD MEDLINE Link].

  30. [Guideline] Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015 Apr. 152 (2 Suppl):S1-S39. [QxMD MEDLINE Link].

  31. Hansen JG, Schmidt H, Rosborg J, Lund E. Predicting acute maxillary sinusitis in a general practice population. BMJ. 1995 Jul 22. 311(6999):233-6. [QxMD MEDLINE Link]. [Full Text].

  32. Hickner JM, Bartlett JG, Besser RE, Gonzales R, Hoffman JR, Sande MA. Principles of appropriate antibiotic use for acute rhinosinusitis in adults: background. Ann Intern Med. 2001 Mar 20. 134(6):498-505. [QxMD MEDLINE Link].

  33. McQuillan L, Crane LA, Kempe A. Diagnosis and management of acute sinusitis by pediatricians. Pediatrics. 2009 Feb. 123(2):e193-8. [QxMD MEDLINE Link].

  34. Savolainen S, Jousimies-Somer H, Karjalainen J, Ylikoski J. Do simple laboratory tests help in etiologic diagnosis in acute maxillary sinusitis?. Acta Otolaryngol Suppl. 1997. 529:144-7. [QxMD MEDLINE Link].

  35. Gordts F, Abu Nasser I, Clement PA, Pierard D, Kaufman L. Bacteriology of the middle meatus in children. Int J Pediatr Otorhinolaryngol. 1999 May 5. 48(2):163-7. [QxMD MEDLINE Link].

  36. [Guideline] Kaplan A. Canadian guidelines for acute bacterial rhinosinusitis: clinical summary. Can Fam Physician. 2014 Mar. 60 (3):227-34. [QxMD MEDLINE Link].

  37. Zalmanovici A, Yaphe J. Steroids for acute sinusitis. Cochrane Database Syst Rev. 2007 Apr 18. CD005149. [QxMD MEDLINE Link].

  38. Williamson IG, Rumsby K, Benge S, Moore M, Smith PW, Cross M, et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial. JAMA. 2007 Dec 5. 298(21):2487-96. [QxMD MEDLINE Link].

  39. van Loon JW, van Harn RP, Venekamp RP, et al. Limited evidence for effects of intranasal corticosteroids on symptom relief for recurrent acute rhinosinusitis. Otolaryngol Head Neck Surg. Nov 2013. 149(5):668-73. [QxMD MEDLINE Link].

  40. Ahovuo-Saloranta A, Borisenko OV, Kovanen N, Varonen H, Rautakorpi UM, Williams JW Jr, et al. Antibiotics for acute maxillary sinusitis. Cochrane Database Syst Rev. 2008 Apr 16. CD000243. [QxMD MEDLINE Link].

  41. Young J, De Sutter A, Merenstein D, van Essen GA, Kaiser L, Varonen H, et al. Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. Lancet. 2008 Mar 15. 371(9616):908-14. [QxMD MEDLINE Link].

  42. Garbutt JM, Banister C, Spitznagel E, Piccirillo JF. Amoxicillin for acute rhinosinusitis: a randomized controlled trial. JAMA. 2012 Feb 15. 307(7):685-92. [QxMD MEDLINE Link].

  43. Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, et al. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. Clin Infect Dis. 2012 Apr. 54(8):e72-e112. [QxMD MEDLINE Link].

  44. Sng WJ, Wang DY. Efficacy and side effects of antibiotics in the treatment of acute rhinosinusitis: a systematic review. Rhinology. 2015 Mar. 53 (1):3-9. [QxMD MEDLINE Link].

  45. Zalmanovici A, Yaphe J. Intranasal steroids for acute sinusitis. Cochrane Database Syst Rev. 2009 Oct 7. CD005149. [QxMD MEDLINE Link].

  46. Kaper NM, Breukel L, Venekamp RP, et al. Absence of evidence for enhanced benefit of antibiotic therapy on recurrent acute rhinosinusitis episodes: a systematic review of the evidence base. Otolaryngol Head Neck Surg. 2013 Nov. 149(5):664-7. [QxMD MEDLINE Link].

  47. Falagas ME, Giannopoulou KP, Vardakas KZ, Dimopoulos G, Karageorgopoulos DE. Comparison of antibiotics with placebo for treatment of acute sinusitis: a meta-analysis of randomised controlled trials. Lancet Infect Dis. 2008 Sep. 8(9):543-52. [QxMD MEDLINE Link].

  48. [Guideline] National Guidelines Clearinghouse. Clinical practice guideline: adult sinusitis. National Guidelines Clearinghouse. Available at //guideline.gov/content.aspx?id=12385. Accessed: September 29, 2010.

  49. Marple BF, Roberts CS, Frytak JR, Schabert VF, Wegner JC, Bhattacharyya H, et al. Azithromycin extended release vs amoxicillin/clavulanate: symptom resolution in acute sinusitis. Am J Otolaryngol. 2010 Jan-Feb. 31(1):1-8. [QxMD MEDLINE Link].

  50. Platt MP, Cunnane ME, Curtin HD, Metson R. Anatomical changes of the ethmoid cavity after endoscopic sinus surgery. Laryngoscope. 2008 Dec. 118(12):2240-4. [QxMD MEDLINE Link].

  51. Huang BY, Lloyd KM, DelGaudio JM, Jablonowski E, Hudgins PA. Failed endoscopic sinus surgery: spectrum of CT findings in the frontal recess. Radiographics. 2009 Jan-Feb. 29(1):177-95. [QxMD MEDLINE Link].

  52. Hnatuk LA, Macdonald RE, Papsin BC. Isolated sphenoid sinusitis: the Toronto Hospital for Sick Children experience and review of the literature. J Otolaryngol. 1994 Feb. 23(1):36-41. [QxMD MEDLINE Link].

  53. DelGaudio JM, Evans SH, Sobol SE, Parikh SL. Intracranial complications of sinusitis: what is the role of endoscopic sinus surgery in the acute setting. Am J Otolaryngol. 2010 Jan-Feb. 31(1):25-8. [QxMD MEDLINE Link].

  54. Anon JB, Jacobs MR, Poole MD, Ambrose PG, Benninger MS, Hadley JA, et al. Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Otolaryngol Head Neck Surg. 2004 Jan. 130(1 Suppl):1-45. [QxMD MEDLINE Link].

  55. Brook I, Gober AE. Dynamics of nasopharyngitis in children. Otolaryngol Head Neck Surg. 2000 May. 122 (5):696-700. [QxMD MEDLINE Link].

  56. Barclay, L. Acute Bacterial Sinusitis Addressed in New AAP Guidelines. Medscape Medical News. Available at //www.medscape.com/viewarticle/806791. Accessed: July 2, 2013.

  57. Chan KH, Abzug MJ, Coffinet L, Simoes EA, Cool C, Liu AH. Chronic rhinosinusitis in young children differs from adults: a histopathology study. J Pediatr. 2004 Feb. 144(2):206-12. [QxMD MEDLINE Link].

  58. Seo J, Kim HJ, Chung SK, Kim E, Lee H, Choi JW, et al. Cervicofacial tissue infarction in patients with acute invasive fungal sinusitis: prevalence and characteristic MR imaging findings. Neuroradiology. 2013 Feb 2. [QxMD MEDLINE Link].

  • Table 1. Dosage, Route, and Spectrum of Activity of Commonly Used First-Line Antibiotics*
  • Table 2. Dosage, Route, and Spectrum of Activity of Commonly Used Second-Line Antibiotics*
  • Table 3. Dosage, Route, and Spectrum of Activity of Commonly Used Intravenous Antibiotics (Second-Line)*

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

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

Table 3. Dosage, Route, and Spectrum of Activity of Commonly Used Intravenous Antibiotics (Second-Line)*

Author

Itzhak Brook, MD, MSc Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, Society for Ear, Nose and Throat Advances in Children, American Federation for Clinical Research, Surgical Infection Society, Armed Forces Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Brian E Benson, MD, FACS Founding Chair, Department of Otolaryngology-Head and Neck Surgery, Hackensack Meridian School of Medicine; Chief, Division of Laryngeal Surgery, Interim Chair, Department of Otolaryngology-Head and Neck Surgery, Attending Surgeon, Hackensack University Medical Center; Co-Chief, Division of Head and Neck Oncology, The John Theurer Cancer Center at Hackensack University Medical Center

Brian E Benson, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, New York Head and Neck Society, New York Laryngological Society

Disclosure: Nothing to disclose.

Linas Riauba, MD Assistant Professor of Clinical Medicine, Department of Medicine, Section of Infectious Disease, University Hospital, University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Linas Riauba, MD is a member of the following medical societies: American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Acknowledgements

Michael Cunningham, DO Sr Clinical Instructor, Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry

Michael Cunningham, DO is a member of the following medical societies: American College of Emergency Physicians, American Osteopathic Association, Medical Society of the State of New York, and National Association of EMS Physicians

Disclosure: Nothing to disclose.

Tracey Quail Davidoff, MD Senior Clinical Instructor, Department of Emergency Medicine, Rochester General Hospital

Tracey Quail Davidoff, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Forensic Examiners, American College of Physicians, and American Medical Association

Disclosure: Nothing to disclose.

Thomas E Herchline, MD Professor of Medicine, Wright State University Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, and Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Erhun Serbetci, MD Director, Department of Otolaryngology, Section of Nose and Sinus Surgery, Associate Professor, International Hospital of Istanbul, Turkey

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

What is the antibiotic of choice for sinusitis?

The course of treatment is usually 5-10 days. First-line therapy at most centers is usually amoxicillin or a macrolide antibiotic in patients allergic to penicillin because of the low cost, ease of administration, and low toxicity of these agents.

Is doxycycline good for sinus infection?

Treatment of suspected bacterial infection is with antibiotics, such as amoxicillin/clavulanate or doxycycline, given for 5 to 7 days for acute sinusitis and for up to 6 weeks for chronic sinusitis.

What is the strongest antibiotic for a severe sinus infection?

Most cases of sinusitis clear up within 10 days. Antibiotics are not needed for acute viral sinusitis. If a secondary bacterial infection should develop, one treatment of choice is amoxicillin-clavulanate (Augmentin). In patients who have severe allergy to penicillin-type drugs, doxycycline is a reasonable alternative.

Related Posts

What antibiotic is good for sinus infection and sore throat

Toplist

Latest post

TAGs