* 급성 세균성 부비동염에서 초기 경험적 항생제는 아목시실린 또는 아목시실린-클라불라네이트입니다.
초기 경험적 항생제 치료에 호전되지 않는 경우에 어떻게 항생제를 선택하면 좋은지에 대한 데이터는 제한적이지만, 처음 사용했던 항생제와 다른 class를 사용하거나 더 넓은 spectrum의 항생제를 사용해야 합니다.
Reasonable options include:
● Amoxicillin-clavulanate 2 g/125 mg extended-release tablets orally twice daily
● Levofloxacin 500 or 750 mg orally once daily
● oxifloxacin 400 mg orally once daily
For penicillin-allergic patients, options include:
● Doxycycline 100 mg orally twice daily or 200 mg orally daily
● Levofloxacin 500 or 750 mg orally once daily
● Moxifloxacin 400 mg orally once daily
As noted above, fluoroquinolones should be reserved for those who have no alternative treatment options as the serious adverse effects associated with fluoroquinolones generally outweigh the benefits for patients with acute sinusitis. A third-generation cephalosporin plus clindamycin is an alternative to fluoroquinolones; this regimen offers broader-spectrum coverage than doxycycline but offers no particular advantage over amoxicillin-clavulanate. Use of clindamycin also carries increased risk of C. difficile infection.
REF. UpToDate 2019.10.30
