The new guideline emphasize that the vast majority of sinus infections are caused by viruses and should not be treated with antibiotics. In those cases the new guidelines call for shorter treatment time than older guidance, which suggested a 10 to 14 days weeks of antibiotic treatment for a bacterial infection. The IDSA guideline suggests that five to seven days is long enough to treat most bacterial infection without encouraging resistance in adults, though children should still receive the longer course.
Because of increasing resistance to amoxicillin (the current standard of care) the guideline recommends amoxicillin-clavulanate as the treatment of choice for acute sinusitis. Amoxicillin-clavulanate is a combination that helps to overcome antimicrobial resistance by inhibiting an enzyme that breaks down the antibiotic.
The guidelines also recommend against other commonly used antibiotics, including azithromycin, clarithromycin and trimethoprim/sulfamethoxazole, because of growing drug resistance.
Whether the sinus infection is bacterial or viral, the use of decongestants and
antihistamines is not recommended as they may make symptoms worse. Nasal steroids can help ease symptoms as may nasal irrigation using a sterile solution, including sprays, drops or liquid. It is also recommended to use acetaminophen for sinus pain and drink plenty of fluids.
The symptoms of a bacterial sinus infection that does warrant prompt attention and possibly antibiotics are:
1. Symptoms that last for 10 or more days and are not improving, or severe symptoms accompanied by a fever of 102 degrees Fahrenheit or higher
2. Facial pain and green nasal discharge that lasts for 3 or 4 days
3. Symptoms that initially improve after 5 to 7 days, but then return and worsen.
