First Line Antibiotic Treatment for Acute Bacterial Sinusitis

Treatment Algorithm for Acute Bacterial Sinusitis

The American Academy of Pediatrics recommends amoxicillin as the first-line antibiotic of choice for uncomplicated acute bacterial sinusitis in situations where antimicrobial resistance is not suspected, at a standard dose of 45 mg/kg/day in 2 divided doses for children and 500 mg twice daily for adults 1, 2, 4
The American Academy of Pediatrics recommends high-dose amoxicillin or amoxicillin-clavulanate in high-risk situations, such as communities with high prevalence of nonsusceptible S. pneumoniae, patients younger than 2 years, patients attending child care, or patients who have received antibiotics within the previous 4-6 weeks 1, 2, 3, 5
For penicillin-allergic patients, the American Academy of Family Physicians recommends cefdinir, cefuroxime, or cefpodoxime as alternative first-line therapies 6

The predominant pathogens in acute bacterial sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, with resistance patterns including 10-15% of S. pneumoniae isolates being nonsusceptible to penicillin and 10-42% of H. influenzae and nearly 100% of M. catarrhalis being β-lactamase positive and nonsusceptible to amoxicillin 1, 3

The optimal duration of antimicrobial therapy is not well established, but recommendations generally range from 7-10 days for most cases, with some experts recommending treatment until the patient is free of symptoms and then for an additional 7 days 2, 6, 7, 8

The American Academy of Allergy, Asthma, and Immunology recommends avoiding inappropriate antibiotic use, such as prescribing antibiotics for viral upper respiratory infections, and recognizing resistance patterns by being familiar with local patterns of antimicrobial susceptibility 1, 3, 4