Systemic Antibiotics in Odontogenic Sinusitis: Indications, Limitations, and Clinical Considerations

Odontogenic sinusitis (ODS) is increasingly recognized as a distinct form of sinonasal disease in which dental and sinus pathology coexist and frequently require coordinated management. Although systemic antibiotics are commonly prescribed, their precise role remains difficult to define because the available literature is heterogeneous and often extrapolated from studies of conventional rhinosinusitis or odontogenic infections. This review critically examines the evidence supporting systemic antibiotic use in ODS, with particular attention to clinical indications, microbiological considerations, therapeutic limitations, and their relationship with dental and sinonasal treatment. The polymicrobial nature of ODS, with frequent involvement of anaerobic organisms, provides a rationale for antimicrobial therapy in selected clinical circumstances. Antibiotics are particularly relevant in patients presenting with systemic manifestations, spreading or rapidly progressive infection, increased host vulnerability, or infectious complications, and may also be useful as temporary therapy when definitive intervention cannot be immediately performed. However, available evidence does not support routine antibiotic use solely on the basis of an ODS diagnosis or radiographic sinus abnormalities. In clinically stable patients with a treatable odontogenic condition, definitive dental treatment remains central to disease resolution, while persistent sinonasal disease may require endoscopic sinus surgery or other sinus-directed intervention. Repeated or progressively broader antibiotic courses in patients with persistent disease should prompt diagnostic and therapeutic reassessment rather than empirical escalation. Overall, systemic antibiotics retain an important but selective role in ODS management. Their use should be guided by the clinical presentation, severity of infection, host factors, and the feasibility of timely definitive treatment, while recognizing the limited direct evidence currently available.