Review Question - QID 109215

This patient presents with a 10-day history of fever, headache, sore throat, purulent mucus draining from the nares, and tenderness of the maxillary sinuses, which suggests a diagnosis of acute bacterial rhinosinusitis. The best initial treatment is amoxicillin-clavulanic acid.

The most common causative organisms of acute bacterial rhinosinusitis (ABRS) are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Due to high rates of beta-lactamase positivity, the first-line therapy for ABRS is amoxicillin-clavulanic acid. Levofloxacin should be used for patients with an allergy to penicillin.

Incorrect Answers:
Answer 1: Amoxicillin alone would not be appropriate management as many isolates of S. pneumoniae, H. influenzae, and M. catarrhalis have been shown to be beta-lactamase positive and therefore nonsusceptible to amoxicillin.

Answer 3: Ampicillin-sulbactam provides coverage against oral anaerobes and is appropriate empiric management of pyogenic odontogenic infections, peritonsillar abscess, and Ludwig’s angina. It is not used in the management of acute bacterial rhinosinusitis.

Answer 4: Clindamycin provides coverage against both oral anaerobes and methicillin-resistant S. aureus (MRSA), and (similar to ampicillin-sulbactam), can be used for pyogenic odontogenic infections, peritonsillar abscess, and Ludwig’s angina. It is not used to treat ABRS.

Answer 5: Levofloxacin may be used as second-line therapy for ABRS in patients with an allergy to penicillin, but amoxicillin-clavulanic acid would be the most appropriate initial choice in this patient.

Bullet Summary:
The treatment of choice for acute bacterial rhinosinusitis is amoxicillin-clavulanic acid to cover the most common causative organisms(S. pneumoniae, H. influenzae, and M. catarrhalis).