Rhinosinusitis - Acute, Bacterial Drug Summary

Last updated: 12 January 2026
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Analgesics (Non-opioid) & Antipyretics

Drug Dosage Remarks
Aspirin 300-900 mg PO 4-6 hourly
Max dose: 4 g/day		 Adverse Reactions
  • GI effects (GI discomfort, nausea, diarrhea, risk of GI bleeding and ulcers); Hematologic effects (inhibition of platelet aggregation which is reversible except with Aspirin)
Special Instructions
  • To be administered with or after food, milk or antiulcer drugs to prevent GI effects
  • Avoid in patients with peptic ulceration, hypersensitivity to Aspirin or other NSAIDs, including those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by Aspirin or other NSAIDs
  • Use with caution in patients with hypertension, renal, hepatic or cardiac dysfunction
Ibuprofen 200-400 mg PO 4-6 hourly as needed
Max dose: 3.2 g/day
Paracetamol (Acetaminophen) 325-650 mg PO 4-6 hourly or
1,000 mg PO 6 hourly
Max dose: 4 g/day		 Adverse Reactions
  • Hematologic effects (thrombocytopenia, leukopenia, pancytopenia, agranulocytosis)
Special Instructions
  • Use with caution in patients with renal or hepatic dysfunction and alcohol dependence

Antibacterial Combinations

Drug Dosage1 Remarks
Co-trimoxazole
(Sulfamethoxazole [SMZ] and Trimethoprim [TM])		 800 mg SMZ/160 mg TM PO 12 hourly Adverse Reactions
  • GI effects (nausea/vomiting, anorexia, diarrhea, rarely antibiotic-associated diarrhea/colitis, glossitis); Dermatologic effects (rash, pruritus, photosensitivity); Hypersensitivity effects (rash, Stevens-Johnson syndrome [SJS]); Urogenital effect (crystallization in the urine); Other effects (renal/hepatic effects, aseptic meningitis)
Special Instructions
  • Maintain adequate fluid intake
  • Contraindicated in patients allergic to sulfonamides
  • Use with extreme caution or not at all in patients with hematological disorders especially megaloblastic anemia due to folic acid deficiency
  • Use with caution in patients with renal impairment or severe hepatic dysfunction and with caution in patients with folate deficiency (may consider administration of Folinic acid)
1Duration of therapy unless otherwise stated: 10-14 days.

Cephalosporins

Drug Dosage1 Remarks
Second Generation
Cefaclor 250-500 mg PO 8 hourly or
750 mg PO 8 hourly
Max dose: 4 g/day		 Adverse Reactions
  • Hypersensitivity effects (urticaria, pruritus, rash, anaphylaxis); GI effects (diarrhea, nausea/vomiting); Other effect (candidal infections)
  • High doses may be associated with CNS effects (encephalopathy, convulsions)
  • Prolonged prothrombin time, prolonged activated partial thromboplastin time, and/or hypoprothrombinemia (with or without bleeding) have been reported and occur most frequently with N-methylthiotetrazole side chain-containing cephalosporins
Special Instructions
  • May be taken with food to decrease gastric distress
  • Use with caution in patients allergic to Penicillin (there may be 10% chance of cross-sensitivity) and with renal impairment
Cefotiam 200-400 mg PO 12 hourly
Cefprozil 250-500 mg PO 12 hourly
Cefuroxime 250 mg PO 12 hourly
Third Generation
Cefdinir 300 mg PO 12 hourly or
600 mg PO 24 hourly
Cefixime 100 mg PO 12 hourly or
400 mg PO as single dose or divided 12 hourly
Cefotaxime 2 g IV 4-6 hourly
Cefpodoxime 200 mg PO 12 hourly
Ceftibuten 400 mg PO 24 hourly
Ceftriaxone 1-2 g IM/IV 12-24 hourly x 5-10 days
1Duration of therapy unless otherwise stated: 10-14 days.

Corticosteroid (Intranasal)

Drug Available Strength Dosage Remarks
Mometasone 50 mcg/dose nasal spray 2 sprays each nostril 12 hourly
Total dose/day: 400 mcg		 Adverse Reactions
  • CNS effects (hypothalamic-pituitary-adrenal axis suppression, psychiatric disturbances, headache); GI effects (dyspepsia, abdominal pain, nausea, pharyngitis); Musculoskeletal effects (myalgia, musculoskeletal pain, back pain); Respiratory effects (URTI, sinusitis, allergic rhinitis); Other effects (immunosuppression, Kaposi sarcoma, oral candidiasis, dysmenorrhea)
  • Risk of systemic effects will depend on dose, potency of the corticosteroid, absorption from the gut, delivery system and use of spacers/drugs pharmacokinetics
  • Long-term use of high-dose steroids may result in cataracts, glaucoma, skin thinning, easy bruising/adrenal suppression
Special Instructions
  • Local effects may be minimized by using a spacer, gargling and spitting out with water
  • Contraindicated in patients with recent nasal septal ulcers, surgery or trauma
  • Use with caution in children as corticosteroids may affect growth and in patients with heart failure, acute myocardial infarction, DM, GI diseases, hepatic/renal impairment, myasthenia gravis, osteoporosis, seizure disorder, thyroid disease

Cough & Cold Preparations

Drug Dosage Remarks
Erdosteine 300 mg PO 8-12 hourly Adverse Reactions
  • GI effects (GI discomfort, taste alterations); Other effects (headache, dyspnea, urticaria, erythema, dermatitis)
Special Instruction
  • Contraindicated in patients with hepatic cirrhosis, hepatic impairment, cystathionine-synthetase enzyme deficiency and severe renal failure
Pseudoephedrine1 60 mg PO 4-6 hourly Adverse Reactions
  • CNS effects (drowsiness, disturbed coordination); Other effects (dry mouth, nose/throat)
Special Instruction
  • Use with caution in patients with high blood pressure or heart conditions
1Combinations with antihistamines are available. Please see the latest MIMS for specific formulations and prescribing information.

Macrolides

Drug Dosage1 Remarks
Erythromycin 250-400 mg PO 6 hourly or
500-800 mg PO 12 hourly		 Adverse Reactions
  • GI effects (nausea/vomiting, abdominal discomfort, diarrhea, antibiotic-associated diarrhea/colitis); Other effect (candidal infections)
  • Dose-related tinnitus/hearing loss has occurred with some macrolides
  • Azithromycin and Clarithromycin tend to cause less GI disturbances than Erythromycin
Special Instructions
  • May take with food to decrease gastric distress
  • Use with caution in patients with hepatic dysfunction

 
Midecamycin 900-1,800 mg/day PO divided 8-12 hourly
Roxithromycin 150 mg PO 12 hourly or
300 mg PO 24 hourly
Spiramycin 6-9 MIU/day PO divided 8-12 hourly
Advanced Macrolides
Azithromycin 500 mg PO 24 hourly x 3 days or
500 mg PO 24 hourly x 1 day followed by 250 mg PO 24 hourly x 4 days
Extended-release: 2 g PO single dose
Clarithromycin 250-500 mg PO 12 hourly x 7-14 days
Extended-release: 1 g PO 24 hourly
Josamycin 1-2 g PO divided 8-12 hourly
1Duration of therapy unless otherwise stated: 10-14 days.

Nasal Decongestants & Other Nasal Preparations*

Drug Available Strength Dosage Remarks
Oxymetazoline 0.01% nasal drops Neonates ≤4 weeks old:
1 drop each nostril 8-12 hourly
Infants <1 year old:
1-2 drops each nostril 8-12 hourly		 Adverse Reactions
  • Local effects: Transient irritation, sneezing, dryness of nasal mucosa; rebound congestion may occur if used frequently or >3-7 days
  • CV effects (increased blood pressure, cardiac irregularities); CNS effects (fever, dizziness, drowsiness, headache); GI effect (nausea)
Special Instructions
  • Not recommended for extended use >3-7 days
  • Contraindicated in patients with narrow-angle glaucoma
  • Use with caution in patients with asthma, hypertension, heart failure, coronary arterial disease, cerebral arteriosclerosis, DM, hyperthyroidism, nasal infection or injury, prostatic hypertrophy
0.025% nasal drops, nasal spray 1-6 years old: 1-2 drops each nostril 8-12 hourly
2-6 years old: 2-3 sprays each nostril 12 hourly
0.05% nasal drops, nasal spray >6 years old and adults: 1-2 drops or 1-2 sprays each nostril 8-12 hourly or
2-3 sprays each nostril 12 hourly
Xylometazoline 0.05% nasal drops, nasal spray 6-11 years old: 1-2 drops or 1-2 sprays each nostril 12-24 hourly
0.1% nasal drops, nasal spray ≥12 years old and adults: 2-3 drops or 1-3 sprays each nostril 8-10 hourly
Other Agents
Sodium chloride 0.65% nasal drops, spray 2-4 drops each nostril 6-8 hourly or as needed or
2 sprays each nostril 6-8 hourly or as needed		 Special Instruction
  • Spray with head upright
0.9% nasal drops, spray 1-2 drops each nostril as needed or 1-2 sprays each nostril as needed
In combination with sea water 1-2 drops each nostril as needed or 1-3 sprays each nostril 8 hourly or as needed Special Instruction
  • Spray with head upright
2.265 g nasal powder Dissolve 1 sachet to 250 mL water in squeeze or wash bottle then irrigate each nostril 12 hourly in the morning and at bedtime Adverse Reactions
  • Earache
Special Instruction
  • If the patient has recently had nasal or sinus surgery, do not blow the nose without checking with the physician
*Decongestants combined with corticosteroid or antihistamine are available. Please see the latest MIMS for specific formulations and prescribing information.

Other Antibiotic

Drug Dosage1 Remarks
Lincosamide
Clindamycin 600-1,800 mg/day PO divided 6-12 hourly Adverse Reactions
  • GI effects (diarrhea, severe antibiotic-related pseudomembranous colitis, nausea/vomiting, abdominal pain, metallic taste); Hypersensitivity effects (rash, urticaria); Dermatologic effects (erythema multiforme, exfoliative/vesiculobullous dermatitis); Other effect (polyarthritis)
Special Instructions
  • Use with caution in patients with GI disease especially with history of colitis, in atopic patients and with renal or hepatic impairment
  • Discontinue if diarrhea occurs
1Duration of therapy unless otherwise stated: 10-14 days.

Other Drugs Acting on the Respiratory System

Drug Dosage1 Remarks
Pelargonium sidoides 1-5 years old:
6.25 mg PO 8 hourly
6-12 years old:
12.5 mg PO 8 hourly or 20 mg PO 12 hourly
>12 years old and adults:
20 mg PO 8 hourly		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea); Hypersensitivity effects (rash, urticaria, pruritus) associated with initial dose
Special Instructions
  • Contraindicated in patients with severe renal and hepatic impairment
  • Use with caution in patients with hematologic disorders and in patients taking anticoagulants
  • After symptoms subside, advise patient to continue use for additional 2 days
1Duration of therapy unless otherwise stated: 10-14 days.

Penicillins

Drug Dosage1 Remarks
Aminopenicillins with or without Beta-lactamase Inhibitors
Amoxicillin (Amoxycillin) 250-500 mg PO 8 hourly or
750-1,000 mg PO 12 hourly		 Adverse Reactions
  • Hypersensitivity effects (rash, urticaria, pruritus, anaphylaxis); GI effects (diarrhea, nausea/vomiting, rarely antibiotic-associated diarrhea/colitis); Other effect (candidal infections)
  • Rarely hematologic effects; Renal and hepatic effects have occurred; High doses may be associated with CNS effects (encephalopathy, convulsions)
Special Instructions
  • Avoid in patients with Penicillin allergy
  • Use with caution in patients with renal impairment
Amoxicillin/clavulanic acid
(Co-amoxiclav, Amoxicillin/clavulanate)		 625 mg PO 8 hourly or
1,000 mg PO 12 hourly
Extended release:
2,000 mg/125 mg PO 12 hourly
Ampicillin/sulbactam
(Sultamicillin)		 375-750 mg PO 12 hourly or
1.5-3 g IM/IV 6-8 hourly or
1.5-12 g IM/IV divided 6-8 hourly
Max dose: 12 g/day IM/IV
Sultamicillin tosylate (Sultamicillin tosilate) 375-750 mg PO 12 hourly
1Duration of therapy unless otherwise stated: 10-14 days.

Quinolones

Drug Dosage1 Remarks
Respiratory Quinolones
Ciprofloxacin 500-750 mg PO 12 hourly or
400 mg IV 12 hourly		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain, dyspepsia); CNS effects (headache, dizziness, sleep disorders, restlessness, drowsiness); Dermatologic effects (rash, pruritus, photosensitivity); Hypersensitivity effects (rash, SJS)
  • Some quinolones have the potential to prolong the QT interval
Special Instructions
  • Administer at least 2 hours before or 3 hours after Al- or Mg-containing antacids, dietary supplements containing Zn or Fe or buffered Didanosine preparations
  • Avoid exposure to strong sunlight or tanning beds
  • Use with caution in patients with epilepsy or history of CNS disorders, impaired renal or hepatic function and in those with glucose-6-phosphate dehydrogenase deficiency

 
Levofloxacin 500 mg PO 24 hourly x 10-14 days or
750 mg PO 24 hourly x 5 days
Moxifloxacin 400 mg PO 24 hourly
Other Quinolones
Ofloxacin 100-200 mg PO 8-12 hourly
Sitafloxacin hydrate 100 mg PO 12 hourly x 7 days
1Duration of therapy unless otherwise stated: 10-14 days.

Tetracyclines

Drug Dosage1 Remarks
Doxycycline 100 mg PO 12 hourly or 200 mg PO 24 hourly x 1 day followed by 100 mg PO 24 hourly Adverse Reactions
  • Dermatologic effect (photosensitivity); GI effects (nausea/vomiting, diarrhea, antibiotic-associated diarrhea/colitis, dysphagia, esophageal ulceration may occur when taken with an insufficient amount of liquid); Other effects (candidal infections, discoloration of teeth, interference with bone growth in young infants/pregnant women)
Special Instructions
  • Take with plenty of fluid while sitting or standing and well before retiring to bed
  • Avoid long exposure to sunlight or tanning beds
  • Avoid in children ≤8 years old, pregnant women and in patients with systemic lupus erythematosus
  • Use with caution in patients with renal or hepatic impairment
1Duration of therapy unless otherwise stated: 10-14 days.

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

Related MIMS Drugs