Broaderspectrum agents

a. If the initial response to antibiotics is unsatisfactory, beta-lactamase-producing bacteria are likely to be present, and broad-spectrum therapy is required.

b. Amoxicillin/clavulanate (Augmentin): adults, 250 mg tid or 875 mg bid; children, 40 mg/kg/d in 3 divided doses.

c. Cefuroxime axetil (Ceftin): adults, 250 mg bid; children, 125 mg bid.

d. Cefixime (Suprax): adults, 200 mg bid; children, 8 mg/kg/d bid.

e. Cefpodoxime (Vantin) 200 mg bid f. Loracarbef (Lorabid): 400 mg bid.

g. Azithromycin (Zithromax): 500 mg as a single dose on day 1, then 250 mg qd.

h. Clarithromycin (Biaxin): 500 mg bid.

4. Penicillin-resistant S. Pneumoniae result from bacterial alterations in penicillin-binding proteins. Highly resistant strains are resistant to penicillin, trimethoprim/sulfamethoxazole (TMP/SMX), and third-generation cephalosporins.The prevalence of multiple-drug resistant S. pneumoniae is 20-35%. High dose amoxicillin (80 mg/kg/d), or amoxicillin plus amoxicillin/clavulanate, or clindamycin are options.

B. Chronic sinusitis is commonly caused by anaerobic organisms. 3-4 weeks of therapy or longer is required.

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