The choice of therapy depends in part upon the clinical picture, associated conditions, and the presence or absence of complications. For the nontoxic patient without evidence of CNS invasion or osteomyelitis, the recommended regimen is trimethoprim-sulfamethoxazole (160/800 mg PO twice a day) or amoxicillin (500 mg PO three times a day) for three to seven days. If the patient has not clearly improved by the third day of therapy, the regimen should be changed to cefpodoxime (200 mg PO twice a day) or cefuroxime (250 mg PO twice a day) for a seven day course.
Patients who are allergic to beta-lactams or sulfonamides can be treated with clarithromycin (500 mg PO twice a day).
In nosocomial sinusitis, sinus culture should be obtained. Specimens are usually obtained either by direct sinus puncture or by sinus endoscopy. Empiric initial treatment should be directed at the common local hospital flora, with therapy then
Antibiotics appear to be of little benefit in the treatment of chronic sinusitis
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