Spectrum: Local Antimicrobial Stewardship, for CHEO-OCTC

Secondary to Subacute or Chronic Sinusitis

Information

Symptom duration (congestion, intermittent fever, headache, post nasal drip, cough etc) is longer than 1-2 months.

Infection Prevention and Control

Droplet / Contact Precautions

Until 24 hours of appropriate antimicrobial therapy

Most Likely Pathogens

S. aureus usually in chronic sinusitis with symptom duration > 1-2 months

Anaerobes in Chronic Sinusitis with symptom duration >2-3 months

Less Likely Pathogens

S. pneumoniae

H. influenzae

M. catarrhalis

Empiric Antimicrobials

CeFURoxime IV

OR

CeFAZolin IV

OR

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

PLUS

MetroNIDAZOLE IV*

*If symptoms for > 2 months

Alternatively, consider

Amoxicillin - Clavulanic acid PO given TID

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.