Which antibiotics are most effective for bacterial sinusitis (sinus infection)?

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

Antibiotics are indicated for sinusitis that is thought to be bacterial, including sinusitis that is severe or involves the frontal, ethmoid, or sphenoid sinuses, since this type of sinusitis is more prone to complications. [47] Penicillins, cephalosporins, and macrolides seem to be equally efficacious. [15] A 5- to 10-day regimen of amoxicillin 500 mg 3 times a day is recommended as first-line therapy. [30, 43, 48]

One study suggests that a single dose of 2 g of extended-release azithromycin may be more effective than a 10-day course of amoxicillin/clavulanate. [49] However, azithromycin is not likely a good choice in sinusitis because symptoms may improve only because of the anti-inflammatory efficacy of the agent and because it has poor efficacy against S pneumoniae and H influenzae. The risk of adverse effects should be weighed against the severity of disease and patient comorbidities prior to initiating antibiotic treatment.

Patterns of bacterial resistance should also be taken into account in the choice of antibiotic. (See Etiology.)


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