When are IV antibiotics indicated in 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 with nosocomial acute sinusitis require adequate intravenous coverage of gram-negative organisms (see Table 3, below). Aminoglycoside antibiotics are usually the drugs of choice for the treatment of such patients because of their excellent gram-negative coverage and sinus penetration. Selection of an antibiotic is usually based on the culture results of attained maxillary secretion.

In addition to surgical management, complications of acute sinusitis should be managed with a course of intravenous antibiotics. Third-generation cephalosporins (eg, cefotaxime, ceftriaxone) in combination with vancomycin provide adequate intracranial penetration, making them a good first-line choice.

Table 3. Dosage, Route, and Spectrum of Activity of Commonly Used Intravenous Antibiotics (Second-Line)* (Open Table in a new window)

Antibiotic

Dosage

Streptococcus pneumoniae

Haemophilus influenzae

Moraxella catarrhalis

Gram-negative

Anaerobic bacteria

Piperacillin

3-4 g IV q4-6h

+++

+

-

+++

+++

Piperacillin/tazobactam

3.375 g IV q6h

+++

+++

+++

+++

++

Ticarcillin

3 g IV q4h

+++

-

-

+++

++

Ticarcillin/clavulanate

3.1 g IV q4h

+++

+++

-

+++

++

Imipenem

500 mg IV q6h

+++

+++

+++

+++

+++

Meropenem

1 g IV q8h

+++

+++

+++

+++

+++

Cefuroxime

1 g IV q8h

+++

+++

+++

++

++

Ceftriaxone

2 g IV bid

+++

+++

+++

+++

++

Cefotaxime

2 g IV q4-6h

+++

+++

+++

+++

++

Ceftazidime

2 g IV q8h

+++

+++

+++

+++

++

Gentamicin

1.7 mg/kg IV q8h

-

+++

+++

++

-

Tobramycin

1.7 mg/kg IV q8h

-

+++

+++

++

-

Vancomycin

1 g IV q6-12h

+++

-

-

-

++

*+, low activity against microorganism; ++, moderate activity against microorganism; +++, good activity against microorganism; -, no activity against microorganism †Does not take into account penicillin-resistant types.


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