Sinusitis: antibiotic therapy recommendations

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Sinusitis

Possible therapeutic alternatives

Sinusitis (Acute) symptoms < 4 weeks.

Usual duration of therapy: 10-14 days

Common pathogens

Augmentin 500mg orally three times daily or 875mg twice daily or

Ceftin (cefuroxime oral) 250mg orally twice daily or

Cefzil 250-500mg orally twice daily or

Vantin 200mg orally twice daily.

BactrimDS twice daily

Severe penicillin allergy:

Clarithromycin 500mg orally twice daily or

Zithromax (Azithromycin) 500mg PO x 1, then 250mg PO qd x 4 days

Drug resistant S.pneumo:

Levofloxacin 500mg orally once daily x 7-10 days

Chronic sinusitis (symptoms > 3 months)

Common pathogens

Same as above. Surgery may be required. Consider reserving antibiotic therapy for acute flares only.

Sinusitis (Hospitalized patient) Intubated etc.

Common pathogens

[Ceftazidime 1 to 2 grams IV every 8 hours + Tobramycin IV] or

Cefepime 2 grams IV every 12 hours or

[Piperacillin 3 to 4 grams IV every 6 hours + Gent or Tobra] or

Imipenem 500mg IV every 6 hours

Antimicrobial Series
References

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Bartlett JG: Empirical therapy of community-acquired pneumonia: macrolides are not ideal choices. Semin Respir Infect 1997 Dec; 12(4): 329-33

Bartlett JG.1998 Pocket Book of Infectious Disease Therapy., Ninth Edition. Baltimore,MD: Williams&Wikins,1998.

Bernstein JM: Treatment of community-acquired pneumonia--IDSA guidelines. Infectious Diseases Society of America. Chest 1999 Mar; 115(3 Suppl): 9S-13S

Drug Information Handbook, 5th Ed. 1997, Lexi-Comp inc.

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Gonzales R, Sande M: What will it take to stop physicians from prescribing antibiotics in acute bronchitis? Lancet 1995 Mar 18; 345(8951): 665-6

Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated urinary tract infection. Infect Dis Clin North Am 1997;11:551-581.

Lipsky BA, Berendt AR.Principles and practice of antibiotic therapy of diabetic foot infections.
Diabetes Metab Res Rev. 2000 Sep-Oct;16 Suppl 1:S42-6.

Mufson MA.Pneumococcal Pneumonia.
Curr Infect Dis Rep. 1999 Apr;1(1):57-64.

Reese RE, Betts RF: A Practical Approach to Infectious Diseases. 4th ed. Boston: Little, Brown, and Company; 1996: 251

Stefani SD, Cadore LP, Villaroel RU, Azevedo S, Machado AL. Antibiotic Selection in the Treatment of Febrile Neutropenia: Current Approach and New Directions.
Braz J Infect Dis. 1998 Jun;2(3):109-117.

Stamm WE, Hooton TM. Management of urinary tract infections in adults. N Engl J Med 1993;329:1328-1334.