What are the Korea CDC guidelines on antibiotic use for the treatment of 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 2017, the Korea Centers for Disease Control and Prevention released guidelines for antibiotic use in adults aged 19 years or above with acute upper respiratory infections, including the following for cases of acute sinusitis [19] :

  • Antibiotics may be prescribed early after diagnosis of acute bacterial sinusitis
  • Empirical antimicrobial therapy should be initiated when the patient shows no improvement of symptoms within 7 days of diagnosis of acute bacterial sinusitis or shows exacerbation of symptoms
  • Antimicrobial therapy should be initiated when the patient shows the following severe symptoms or examination findings: fever of greater than 39°C (102°F), facial pain, or purulent nasal discharge lasting 3-4 days
  • Amoxicillin or amoxicillin/clavulanate are recommended for initial empirical therapy for acute bacterial sinusitis in adults
  • High doses of amoxicillin or amoxicillin/clavulanate should be considered for patients in areas with high prevalence of penicillin-resistant S pneumoniae, patients with severe symptoms, older patients, patients with recent hospital admission, patients with a history of antimicrobial therapy within the past month, and immunocompromised patients
  • For patients with type IV hypersensitivity to penicillin (eg, rash), doxycycline or fluoroquinolones or third-generation cephalosporins or clindamycin may be considered
  • For type I hypersensitivity to penicillin (eg, anaphylaxis), all beta-lactam antibiotics (eg, cephalosporins) should not be used; non–beta-lactam antibiotics should be used
  • Empirical antibiotic therapy should be maintained for a short period (within 5-10 days or 4-7 days of symptom/sign improvement) unless the patient has severe acute sinusitis
  • Second-line therapy should be considered when patients' symptoms worsen within 72 hours of initial empirical therapy or when patients show no improvement even after 3–5 days of treatment
  • Drugs such as ampicillin/sulbactam, ceftriaxone, cefotaxime, levofloxacin, and moxifloxacin may be used for severe conditions that require hospitalization
  • Surgical treatment may be considered when recurrent acute sinusitis is nonresponsive to appropriate drug therapy

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