Spectrum: Local Antimicrobial Stewardship, for CHEO-OCTC

Secondary to acute sinusitis

Information

Symptoms of sinusitis (congestion, discharge, fever, headache etc) duration is usually less than 28 days.

Group A streptococcus may present with more fulminant symptoms and high fever.

Infection Prevention and Control

Droplet / Contact Precautions

Until 24 hours of appropriate antimicrobial therapy

Most Likely Pathogens

S. pneumoniae

S. pyogenes (GAS)

Less Likely Pathogens

H. influenzae

M. catarrhalis

Streptococcus anginosus group

Empiric Antimicrobials

Ampicillin IV

OR

CeFURoxime IV

OR

CefTRIAXone IV - empirically if CNS symptoms present or suspicion of intracranial extension pending imaging/LP

Consider for step-down

Amoxicillin PO

OR

Amoxicillin-Clavulanic Acid* PO given TID

*if treated with Cefuroxime IV

Usual Duration

14 days total in the majority of cases.

May be longer (up to 21 days) if orbital abscess is present and/or high extent of sinus involvement.