What are the IDSA guidelines on treatment for acute sinusitis?

Updated: Apr 22, 2020
  • Author: Ted L Tewfik, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

In contrast to the AAO-HNSF guideline, the IDSA guidelines recommend initiation of antimicrobial therapy with amoxicillin-clavulanate rather than amoxicillin alone, as soon as the clinical diagnosis of ABRS is established. Either doxycycline or a respiratory fluoroquinolone (levofloxacin or moxifloxacin) is recommended as an alternative agent for empiric antimicrobial therapy in adults who are allergic to penicillin. [15] However, in 2016 the US Food and Drug Administration (FDA) issued an advisory that the serious side effects associated with fluoroquinolone antibacterial drugs generally outweigh the benefits for patients with sinusitis and that fluoroquinolones should be reserved for patients who do not have alternative treatment options. [17]  Patients who clinically worsen after 3 days of empiric antimicrobial therapy with a first-line agent or who do not improve after 3-5 days of such treatment should be evaluated for the possibility of resistant pathogens, a noninfectious etiology, a structural abnormality, or other causes for treatment failure. [15]

Additionally, the IDSA recommends intranasal saline irrigation and intranasal corticosteroids as adjunct treatments. [15]


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