Acute Bacterial Rhinosinusitis Empiric Treatment
Bactrim (trimethoprim-sulfamethoxazole, TMP-SMX) is not recommended for empiric treatment of acute bacterial rhinosinusitis because of high resistance rates among common bacterial pathogens. [1]
Empiric Use of TMP-SMX
TMP-SMX should not be selected as empiric therapy for acute bacterial rhinosinusitis. [1]
Reasons for Avoiding TMP-SMX Empirically
TMP-SMX has high resistance rates among Streptococcus pneumoniae and Haemophilus influenzae in the United States. [1]
Situations Where TMP-SMX May Still Be Considered
TMP-SMX may be considered only when an organism is documented as susceptible on culture or when antimicrobial selection is guided by susceptibility rather than empiric coverage. [1]
Appropriate Timing to Treat Sinusitis With Antibiotics
Antibiotics are indicated only when clinical features suggest acute bacterial rhinosinusitis rather than viral acute rhinosinusitis. [1]
Alternative Empiric Options
For empiric therapy of acute bacterial rhinosinusitis, guideline-recommended options are selected based on beta-lactam tolerance and local resistance patterns rather than TMP-SMX. [1]