Adult Outpatients: Respiratory Tract Infections: Sinusitis

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Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.  Some antimicrobials are restricted (ID-R).  Click on link for guidelines on obtaining authorization.

Diagnosis

Common Pathogens

Drug(s) of First Choice

Alternative Drug(s)

Comments

Acute Sinusitis

Viruses

S. pneumoniae

H. influenzae

M. catarrhalis

Amoxicillin 500 mg PO TID X 5-7 days

For severe PCN allergy:

Doxycycline 100 mg PO BID X 5-7 days

 

 

Majority of cases are viral.

 

Consider treatment only in presence of fever, purulence or bloody discharge following an upper respiratory infection if symptoms persist for 7-10 days suggesting bacterial etiology.

Chronic Sinusitis

 

Viruses

S. pneumoniae

H. influenzae

M. catarrhalis

Anaerobes

Staph. aureus

Enterobacteriacae 

Amoxicillin/clavulanate

875 mg/125 mg PO BID X 10-14 days

OR 

Amoxicillin/clavulanate CR 2 g BID X 10-14 days if drug-resistant Streptococcus pneumonia

 

For severe PCN allergy:

Ciprofloxacin 500 mg PO BID

OR

Levofloxacin 500 mg PO daily x 10-14 days

EITHER OF ABOVE WITH OR WITHOUT*:

Clindamycin 300 mg PO TID

Consider otolaryngology consult to rule out anatomic abnormality.

 

If acute exacerbation, treat as acute sinusitis.

 

HIV positive patients may need a 2-3 week course.

 

*Consider clindamycin if anaerobes and/or S. aureus are high on the differential.