Although most cases of acute
rhinosinusitis are caused by viruses, acute bacterial
rhinosinusitis is a fairly common complication. Even though most patients with acute
rhinosinusitis recover promptly without it,
antibiotic therapy should be considered in patients with prolonged or more severe symptoms. To avoid the emergence and spread of
antibiotic-resistant bacteria, narrow-spectrum
antibiotics such as
amoxicillin should be used for 10 to 14 days. In patients with mild disease who have
beta-lactam allergy,
trimethoprim/sulfamethoxazole or
doxycycline are options. Second-line
antibiotics should be considered if the patient has moderate disease, recent
antibiotic use (past six weeks), or no response to treatment within 72 hours.
Amoxicillin-
clavulanate potassium and
fluoroquinolones have the best coverage for Haemophilus influenzae and Streptococcus pneumoniae. In patients with
beta-lactam hypersensitivity who have moderate disease, a
fluoroquinolone should be prescribed. The evidence supporting the use of ancillary treatments is limited.
Decongestants often are recommended, and there is some evidence to support their use, although topical
decongestants should not be used for more than three days to avoid rebound congestion. Topical
ipratropium and the
sedating antihistamines have
anticholinergic effects that maybe beneficial, but there are no clinical studies supporting this possibility. Nasal irrigation with hypertonic and
normal saline has been beneficial in chronic
sinusitis and has no serious adverse effects. Nasal
corticosteroids also may be beneficial in treating chronic
sinusitis. Mist,
zinc salt lozenges,
echinacea extract, and
vitamin C have no proven benefit in the treatment of acute bacterial
rhinosinusitis.