Acute
- symptoms < 4 weeks
- ≤ 3 episodes/ year
The use of topical (intranasal) corticosteroids is controversial but may offer some benefit in allergic rhinosinusitis. Recent evidence indicates they are not of benefit in established acute bacterial sinusitis characterized by thick secretions, closure of the ostium and systemic symptoms. Systemic corticosteroids are not recommended.
Usual Pathogens
S. pneumoniae
H. influenzae
M. catarrhalis
Occasionally:
S. aureus
Group A Streptococci
Anaerobes
Mild-moderate symptoms < 10 days
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Symptomatic therapy |
Symptoms > 10 days or worsening after 5-7 days
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Amoxicillin | 500mg-1g PO tid | 5-7 days |
Penicillin allergy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Doxycycline | 200mg PO once, then 100mg PO bid | 5-7 days |
Severe/Immunocompromised
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Amoxicillin | 1g PO bid | 5-7 days |
| + | ||
| Amoxicillin-clavulanate | 875mg PO bid |
Nonsevere ß-lactam allergy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Ceftriaxone | 1-2g IV daily | 5-7 days |
Severe ß-lactam allergy/anaphylaxis
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Levofloxacin | 750mg PO daily | 5 days |