Pseudomonas Sphenoid Sinusitis

Hi
Thank you in advance for reading. My sister 51 yrs of age has been just been diagnosed with 4 + Pseudomonas on tissue culture after sphenoid sinus explorative surgery due to changes in her vision/severe headache starting two weeks prior but 5 months post concurrent acute onset medial strabismus (diagnosis open during this time). One week after emergency hospitalization for imaging/CSF tap and exploratory surgery the cultures are back and she has been prescribed Ciprofloxacin and Amoxicillin/Clavulanic acid. The intake at the infectious disease referral center could not see her for 10 days to start IV antibiotics. How imperative is it that she be started on IV antibiotics- older studies note that it should be immediate. I don't understand the Amox/Clav given more than 95% chance this will not be effective and only cause intestinal issues. She has not had any follow up exam to reevaluate the optic disk edema noted at the time of emergency hospitalization when she was finally referred to a neuro-ophthalmologist. This seems unusual to me. How important is local control for the pseudomonas together with oral/IV antibiotics? Are there procedures to place antibiotic impregnated packing? How often should she be reevaluated? The ENT office seems to be taking the pseudomonas diagnosis less seriously than the neuro-opthalmologist who got her started immediately on the antibiotics. Follow up appt pending with ENT 10 days post procedure. She has not had any improvement in her vision or strabismus but it has also not deteriorated. Reading the literature it appears there may be some hope that over several months there may be some improvement but I wonder if anyone can say more specifically given the chronic nature of her disease. To complicate matters she has had chronic sinusitis for a long time and reconstructive nasal surgery that went well in June 2024. So I recognize the ability to prognosticate is likely extremely limited. I did see one case that improved over 17 months. Thank you for your support and any possible advice. Do you suggest any specific questions we should be asking? Sincerely Julie- concerned sis.