What are the University of Michigan Health System 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

The University of Michigan Heath System ABRS treatment recommendations include [16] :

  • Amoxicillin and trimethoprim/sulfamethoxazole as first-line agents
  • First-line alternatives (eg, doxycycline, azithromycin) should only be given to patients allergic to both first line drugs
  • The initial course of antibiotics should be 10-14 days, except for azithromycin, which should be prescribed for 3 days
  • For partial, but incomplete, resolution after an initial course of antibiotics, extend the duration of antibiotic therapy by an additional 7-10 days for a total of 3 weeks of antibiotics
  • For minimal or no improvement with initial treatment, reevaluate the diagnosis and consider changing to an antibiotic with broader coverage that includes resistant strains; options include amoxicillin at high dose, amoxicillin-clavulanate, levofloxacin, and moxifloxacin
  • Ciprofloxacin should be avoided due to limited activity against  Streptococcus pneumoniae
  • Avoid telithromycin, because risks for hepatotoxicity, loss of consciousness, and visual disturbances may outweigh potential benefits for ABRS.

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