Antibiotic therapy for sinusitis


Sinusitis, also called sinusitis, is an acute or chronic inflammation of the lining of the sinuses.

Such inflammation may be viral or bacterial, and is often accompanied by rhinitis (chills) or pharyngitis (pharyngitis).

There are four paranasal sinuses that can be affected, namely the ethmoidal cells, the frontal sinuses, the maxillary sinuses or the sphenoid sinus.
Most commonly, the antrum and ethmoidal cells ( see also: Inflammation of ethmoidal cells) are affected by sinusitis.

One divides the inflammation according to localization, course and origin, and differentiates it thus.
If all paranasal sinuses are affected at the same time, it is called pansinusitis .

The following article deals more closely with the antibiotic therapy of sinusitis.

antibiotic therapy

An antibiotic is a drug treatment with antibiotics, which has the goal to destroy microorganisms such as bacteria and fungi.

First and foremost, however, bacteria are the target of antibiosis.
Antibiotics are powerless against viruses, which is why not every sinusitis can be treated with antibiotics.

Antibiotics continue to differ in their spectrum of activity, so not every antibiotic is effective against every bacterium.
The opposite is true: many bacteria have resistance to certain classes of antibiotics.

Thus, the antibiotic therapy of sinusitis is only effective and useful if bacteria are the cause of the inflammation and at best known to which bacterium it is.
Only then can a targeted therapy be carried out.

Bacterial infections, however, are the cause only in 25-30% of acute sinusitis. Most of the inflammation is viral.
There are indications, however, that can speak for a bacterial infection:

  • These are on the one hand a disease duration of more than 7 days,
  • a unilateral purulent nasal discharge
  • as well as one-sided facial pains, which express themselves in the typical feeling of pressure, that one feels in a sinusitis.

Bilateral complaints speak more for a viral cause.

If there is a proven bacterial cause or a strong suspicion, antibiotic therapy may be initiated.
Also, in chronic sinusitis in long-term therapy, antibiotics are prescribed in addition to other therapeutic approaches.

The type of antibiotic depends on the bacterial pathogen present. Most of them are staphylococci, streptococci, hemophilus influenzae and pneumococci, which cause sinusitis.

Overview of potentially effective antibiotics

Here is an overview of potentially effective antibiotics:

  • Antibiotics effective against staphylococci :
    Staphylococci are gram-positive bacteria, which can cause nasal sinus inflammation in addition to many other diseases.
    In particular, the germ Staphylococcus aureus is involved, which is in 30% of all people in the nasal entrance, the nasal cavity and the pharynx entrance.
    In very severe cases (this is generally the case), the bacterial infection can also spread to neighboring bone structures and thus cause, for example, damage to the eyes or the brain.
    Staph. Aureus can also cause meningitis (meningitis).
    Staphylococci are generally inherently resistant to penicillin, so it is ineffective.
    One therefore treats mainly with cephalosporins of the 1st and 2nd, but also the 3rd generation.
    Otherwise, penicillin may also be given in combination with a penicillinase inhibitor such as clavulanic acid . This penicillinase inhibitor inhibits the enzyme of the bacteria, which would otherwise destroy the penicillin.
    Meanwhile, about 20% of the staphylococcal strains are also capable of forming other resistances, so that methicillin and oxacillin-resistant Staph. Aureus and Staph. epidermidis strains speaks.
    By and large, they are known as the multi-drug resistant bacteria MRSA and MRSE. Here are glycopeptides such as vancomycin.
    Treatment may take up to 4 weeks, depending on how severe the infection and disease are.
  • Antibiotics effective against streptococci :
    Streptococci are also Gram-positive bacteria whose incubation period (time between infection and first onset of symptoms) is about 2 to 4 days.
    In contrast to staphylococci, they are almost always sensitive to penicillin, so that treatment with penicillin makes sense here.
    Usually it is treated with the drug for more than 10 days.
    In very severe disease with sepsis (blood poisoning), meningitis or existing endocarditis, the therapy is high-dose parenterally administered.
    For penicillin allergy, macrolide antibiotics such as erythromycin and clarithromycin can be given.
  • Antibiotics effective against pneumococci : These pathogens are similar to streptococci, causing both exogenous ( exogenous ) and endogenous (internal) infections.
    So they can be transmitted by droplet infection or, starting from the pharynx, where they are, trigger an infection.
    Most commonly they cause sinusitis, otitis (ear inflammation), canaliculitis ( irritation of the tear duct) and conjunctivitis (conjunctivitis).
    They also trigger pneumonia (pneumonia).
    There are several different subspecies of the germ, some of which can be vaccinated.
    If you are ill, there are some antibiotics that are suitable for treatment.
    As a rule, cephalosporins of the 3rd generation are prescribed. These are also very effective in the dreaded complication of hood meningitis.
    Otherwise, penicillins and gycopeptides such as vancomycin are also a way to treat.
  • Antibiotics effective against Hemophilus influenzae :
    This bacterium is a gram-negative rod, which is to a small extent also in the pharynx.
    It causes similar diseases as the pneumococcus, but is less common than the cause.
    Hemophilus influenzae typically causes not only sinusitis but also otitis (ear inflammation), canaliculitis (inflammation of the lacrimal duct) and conjunctivitis (conjunctivitis), purulent bronchitis (inflammation of the bronchi) and epiglottitis (epiglottis).
    It can also lead to meningitis, sepsis and pneumonia.
    Rarely, this germ can form resistance to penicillin.
    It is therefore preferred Augmentan, a macrolide antibiotics or cephalosporins of the 2nd and 3rd generation.
    Augmentan is a combination supplement containing the antibiotic amoxicilin and the penicillin inhibitor clavulanic acid.

What to do if the antibiotic does not help?

In case of an acute sinus infection, an antibiotic, if it works well, should shorten the duration of the disease by an average of 2 to 3 days. Symptoms should improve after 1 to 2 days under antibiotic therapy. If this is not the case, you should consult your doctor and discuss the procedure with him. However, it is important that the antibiotic does not just settle if you do not have intolerance or severe side effects. Discontinuation of the antibiotic should be well considered, as incomplete antibiotic use promotes resistance to bacteria. This will make them less treatable.

Antibiotic therapy in pregnancy

Antibiotics can also be used during pregnancy to combat bacterial, acute sinusitis. The treatment should be weighed exactly as well as outside of a pregnancy strictly. However, if the criteria for treatment with an antibiotic are present, this should also be taken. The complications of a bacterial sinusitis can otherwise be dangerous for the unborn child. Penicillins such as amoxicillin, which is also the drug of choice, are well tolerated in pregnancy and have no negative effects on the unborn child. Be advised by an ENT specialist in detail.

How long does the antibiotic have to be taken?

In acute sinusitis, antibiotics are usually prescribed for 5 to 10 days if they make sense. It is important to completely take the antibiotic for the specified period of time. Of course, an exception is an intolerance, allergic reaction or severe side effects.

How long does it take for an improvement?

An improvement occurs when the antibiotic is effective against the bacteria. The prerequisite is that the sinusitis is bacterially caused. A good preselection of patients who are likely to have a bacterial infection based on their symptoms will improve the effectiveness of the therapy. Then after about 1 to 2 days under antibiotic therapy an improvement should occur. However, it can take 3 to 4 days, which is individually very different.

What is the risk of infection with sinusitis with antibiotics?

As a rule, the risk of infection decreases approximately from the third intake day of the antibiotic. A precise time is difficult, however, possible. The antibiotic must nevertheless be taken to the end, because only then the killing of all bacteria can be guaranteed.

Is it allowed to exercise if you have sinusitis and take antibiotics?

Sports activities should be avoided during an acute infection. Although sport is in principle very conducive to health, in a disease phase, you should be careful. Also you should not be fooled by the decaying symptoms of taking antibiotics: The disease is not over at this time. Physical exertion during an infection can lead to the spread of the disease. In addition, pathogens can be carried to the heart and heart valves. Particularly feared are myocarditis, which can arise in particular if you do sports in fever. As a rule of thumb, do not use your training for up to 3 days after the illness has passed and all antibiotics have been taken. Then start with a light intensity and increase slowly. If you are unsure when to start training again and what intensity is appropriate, do not hesitate to consult your doctor. He can judge your health professionally and help you with advice.


Antibiotic therapy is indicated if the cause of sinusitis is bacterial.

The selected antibiotic depends on the pathogen, which is secured as the cause or is just suspected.

The pathogens that cause sinusitis are staphylococci, streptococci, pneumococci, or hemophilus influenzae .
They differ in their sensitivity to the antibiotics, so that different drugs are used in therapy.

If pneumococci are the causative agents, most commonly used are 3rd generation cephalosporins or glycopeptides such as vancomycin.

Hemophilus influenzae are mostly taken from augmentan or cephalosporins of the 2nd and 3rd generation. Macrolides can also be used.

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