Chronic Sinusitis

Diagnosis Common Pathogens Drug(s) of First Choice Alternative Drug(s) Comments Expected Duration
Chronic sinusitis

Viruses

Strep. pneumoniae

H. influenzae

M. catarrhalis

Anaerobes

Staph. aureus

Enterobacteriacae

Amoxicillin/

clavulanate

875mg/125mg PO BID

For severe beta-lactam allergy:

Ciprofloxacin

OR

Levofloxacin

Either above WITH OR WITHOUT*:

Clindamycin

Otolaryngology consult recommended to rule out anatomic abnormality.

Symptomatic relief can include acetaminophen, ibuprofen, topical intranasal steroids, and/or nasal saline irrigation

If acute exacerbation, treat as acute sinusitis.

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

10-14 days