Nr 661 Acute Sinusitis Pharmacologic Management
Reserve antibiotics for:
- Persistent and not improving symptoms > 10 days
- Severe symptoms for > 3-4 days
Quinolones
Mechanism of Action: Quinolones inhibit the action of DNA gyrase, an enzyme essential for bacterial replication.
Levofloxacin (Levaquin®)
- Dosage:
- Adults (>18 years):
- Usual: 500 mg once daily for 10-14 days
- Alternative: 750 mg daily for 5 days
- Children: Not recommended
- How supplied:
- Tabs: 250 mg, 500 mg, 750 mg
- Oral solution: 480 mL
- Comments:
- Reduce dose for impaired renal function.
- Avoid drugs that prolong the QT interval.
- Absorption significantly decreased by dairy products, multivitamins, and calcium-containing products.
- Possible increased risk of tendinitis or tendon rupture.
- Causes photosensitivity; monitor for this side effect.
- Not recommended for children under 18 years or pregnant women due to potential impairment in bone and cartilage formation.
- Monitor for hypoglycemic reactions in patients with diabetes.
Moxifloxacin (Avelox®)
- Dosage:
- Adults: 1 tablet once daily for 5-7 days
- Children: Not indicated
- How supplied:
- Comments:
- Similar considerations as levofloxacin, particularly regarding QT prolongation and photosensitivity.
- Avoid in pregnancy and lactation unless absolutely necessary.
PREGNANCY/LACTATION CONSIDERATIONS
- Sinusitis in Pregnancy: May be aggravated by physiologic nasal congestion due to pregnancy.
- Decongestant Use: Mild decongestants are considered safe for short-term use, but their effectiveness is not proven.
- Antibiotic Use: Avoid unless absolutely necessary. Tetracyclines and quinolones should be avoided during pregnancy or lactation due to potential risks.
CONSULTATION/REFERRAL
- Consider consultation or referral to a specialist if symptoms persist despite treatment, or if there are concerns regarding the management of sinusitis in pregnancy or other special populations.
