Treatment of Chronic Sinusitis

Key Evidence Against Antibiotic Use

• The European guidelines (EPOS 2020) show that in chronic rhinosinusitis without nasal polyps (CRSsNP), amoxicillin-clavulanate demonstrated no statistically significant differences compared to other antibiotics or alternative treatments in multiple randomized trials 2
• Studies comparing amoxicillin-clavulanate to cefuroxime in chronic rhinosinusitis patients showed no significant difference in clinical cure rates or bacteriologic eradication 2

Recommended Treatment Approach

• The American College of guidelines recommends intranasal corticosteroids (such as mometasone furoate) as the primary therapeutic intervention for chronic sinusitis with acute exacerbation 1
• Reserve antibiotics for true acute bacterial sinusitis or when there is evidence of bacterial superinfection with systemic symptoms (high fever, severe facial pain, periorbital complications) 1

When Antibiotics ARE Indicated

• Amoxicillin-clavulanate 875/125 mg twice daily for 10-14 days is appropriate for acute bacterial sinusitis with risk factors for resistant organisms, as recommended by the guidelines 1
• Duration should be 10-14 days or until symptom-free for 7 days, according to the Journal of Allergy and Clinical Immunology 3, 1

Alternative Considerations

• Consider short-term oral corticosteroids for marked mucosal edema or severe symptoms in patients who fail to respond to intranasal corticosteroids and saline irrigation, as suggested by the guidelines 1
• Evaluate for underlying allergic rhinitis, anatomic abnormalities, or immunodeficiency if symptoms are recurrent (≥3 episodes per year), as recommended by the guidelines 1