- The duration of antibiotic therapy is generally 5–7 days for uncomplicated cases in adults, as per IDSA 2012 guidelines
- Antibiotic therapy should be initiated as soon as the clinical diagnosis of ABS is established
- In the event that patients are allergic to penicillin, alternative agents such as doxycycline or respiratory fluoroquinolones (levofloxacin or moxifloxacin) can be administered, as per IDSA 2012 guidelines
- Macrolides (clarithromycin and azithromycin) are not recommended for empiric therapy due to high resistance rates among S. pneumoniae (approximately 30%)
Symptomatic treatment
- Symptomatic treatment can include analgesics, topical intranasal corticosteroids, and intranasal saline irrigation for symptomatic relief in patients with ABS
A randomized clinical trial suggested that high-dose amoxicillin plus clavulanate did not appear to provide additional benefit compared to standard-dose amoxicillin plus clavulanate in adults treated for clinically diagnosed acute sinusitis
In conclusion, the treatment of ABS involves a combination of antibiotic therapy, primarily with amoxicillin/clavulanate, and symptomatic treatment. The choice of antibiotic may be adjusted based on patient allergies and local resistance patterns. The duration of therapy is typically 5–7 days for uncomplicated cases. High-dose amoxicillin plus clavulanate does not appear to provide additional benefit over standard-dose therapy.