When is second-line antibiotic therapy indicated for the treatment of acute sinusitis (sinus infection)?

Updated: Mar 01, 2018
  • Author: Itzhak Brook, MD, MSc; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Patients who live in communities with a high incidence of resistant organisms, those who fail to respond within 48-72 hours of commencement of therapy, and those with persistence of symptoms beyond 10-14 days should be considered for second-line antibiotic therapy (see Table 2, below).

The most commonly used second-line therapies include amoxicillin-clavulanate, second- or third-generation cephalosporins (eg, cefuroxime, cefpodoxime, cefdinir), macrolides (ie, clarithromycin), fluoroquinolones (eg, ciprofloxacin, levofloxacin, moxifloxacin), and clindamycin.

In patients with dental causes of sinusitis or those with foul-smelling discharge, anaerobic coverage using clindamycin or amoxicillin with metronidazole is necessary.

Table 2. Dosage, Route, and Spectrum of Activity of Commonly Used Second-Line Antibiotics* (Open Table in a new window)

Antibiotic

Dosage

Streptococcus pneumoniae

Haemophilus influenzae

Moraxella catarrhalis

Anaerobic bacteria

Sensitive

Intermediate

Resistant

Amoxicillin/

clavulanate

500 mg PO tid

+++

++

+

+++

+++

+++

Cefuroxime

250-500 mg PO bid

+++

++

+

+++

++

++

Cefpodoxime

+

cefixime

200 mg PO bid

400 mg/d PO

-

++

+++

-

++

-

+

+++

+++

+++

++

-

Ciprofloxacin

500-750 mg PO bid

++

+

+

++

+++

+

Levofloxacin

500 mg/d PO

+++

+++

+++

+++

+++

++

Trovafloxacin

200 mg/d PO

+++

+++

+++

+++

+++

+++

Clindamycin

300 mg PO tid

+++

+++

++

-

-

+++

Metronidazole

500 mg PO tid

-

-

-

-

-

+++

*+, low activity against microorganism; ++, moderate activity against microorganism; +++, good activity against microorganism; -, no activity against microorganism


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