Acute bacterial sinusitis

Acute bacterial sinusitis is most often caused by the same bacteria implicated in acute otitis media S. pneumoniae and H. influenzae. These organisms are responsible for about 70% of bacterial causes of acute sinusitis in both adults and children. Chronic sinusitis can be polymicrobial, with an increased prevalence of anaerobes as well as less common pathogens including gram-negative bacilli and fungi. 

TABLE 44-10 Dosing Guidelines for Acute Bacterial Sinusitis ... 

Nasal decongestant sprays such as phenylephrine and oxymetazoline that reduce inflammation by vasoconstriction are often used in sinusitis. Use should be limited to the recommended duration of the product to prevent rebound congestion. Oral decongestants may also aid in nasal or sinus patency. To reduce mucociliary function, irrigation of the nasal cavity with saline and steam inhalation may be used to increase mucosal moisture, and mucolytics (e.g., guaifenesin) maybe used to decrease the viscosity of nasal secretions. Antihistamines should not be used for acute bacterial sinusitis in view of their anticholinergic effects that can dry mucosa and disturb clearance of mucosal secretions. 

Amoxicillin is first-line treatment for acute bacterial sinusitis. It is cost effective in acute uncomplicated disease, and initial use of newer broad-spectrum agents is not justified. The approach to treating acute bacterial sinusitis is given in Table 44-9. Dosing guidelines are given in Table 44-10. 

Acute bacterial sinusitis 500 mg/day for 3 days or 2 g as a single dose of Zmax. 

Acute bacterial sinusitis 10 mg/kg oral suspension once daily for 3 days. Community-acquired pneumonia mg/kg oral suspension as a single dose on the first day followed by 5 mg/kg on days 2 through 5. 

Acute bacterial sinusitis Caused by S. pneumoniae, H. influenzae, M. catarrhalis, or Staphylococcus aureus. 

Acute bacterial sinusitis 800 mg oral (2 tablets of Once daily 5 days... 

Acute bacterial sinusitis PO(Zmax) 2 gas a single dose. PO 500 mg/day for 3 days. Cervicitis PO 1-2 gas single dose. 

Church D, et al. Efficacy of moxifloxacin in the treatment of acute bacterial sinusitis caused by penicillin-resistant Streptococcus pneumoniae. In 40th Interscience Conference on Antimicrobial Agents and Chemotherapy, Abstract 833. Toronto, 2000. 

In comparative trials involving commonly used regimens, levofloxacin had equivalent if not greater activity in the treatment of community-acquired pneumonia, acute bacterial exacerbations of chronic bronchitis, acute bacterial sinusitis, acute pyelonephritis, and complicated urinary tract infection (5). 

Benninger MS. Amoxicillin/clavulanate potassium extended release tablets a new antimicrobial for the treatment of acute bacterial sinusitis and community-acquired pneumonia. Expert Opin Pharmacother 2003 Oct 4(10) 1839-1846. 

Amoxicillin is first-line treatment for acute bacterial sinusitis. Since there is no difference in clinical outcome among... 

Antihistamines should not be nsed for acute bacterial sinusitis in view of their antichoUneric effects that can dry mucosa and distnrb clearance of mucosal secretions. Second-generation antihistamines may play a role in chronic sinusitis where allergy is a component. Glucocorticoids intranasaUy decrease tissue inflammation and edema however, delayed onset limits their nsefulness in acnte sinnsitis. 

Amoxicillin is first-line treatment for acute bacterial sinusitis. 

Azithromycin is a macrolide (erythromycin, clarithromycin, and azithromycin) that interferes with microbial protein synthesis. It is indicated in the following conditions. Adults treatment of infections of the respiratory tract, acute bacterial sinusitis, acute bacterial exacerbations of COPD, community-acquired pneumonia, Mycobacterium avium complex, pelvic inflammatory disease, pharyngitis/tonsilli-tis, skin and skin structure infections, and sexually transmitted diseases caused by susceptible organisms. Children treatment of acute bacterial sinusitis, acute otitis media caused by susceptible organisms, community-acquired pneumonia, pharyngitis/tonsillitis caused by S. pyogenes in patients who cannot use first-line therapy. 

Moxifloxacin hydrochloride is a fluoroquinolone/anAbiotic. It interferes with microbial DNA synthesis. Moxifloxacin is indicated in the treatment of acute bacterial sinusitis, acute bacterial exacerbation of chroific bronchitis, community-acquired pneumonia, uncomplicated skin and skin structure infections, and conjunctivitis caused by susceptible organisms. 

Telithromycin is a ketolide, which interferes with microbial protein synthesis. It is indicated in the treatment of acute bacterial exacerbation of chronic bronchitis, acute bacterial sinusitis, and community-acquired pneumonia caused by strains of susceptible organisms. 

In June 2001, FDA approved Sanofi-Aventis s new antibiotic Ketek to treat pneumonia after finding that it was effective against a virulent antibiotic-resistant bacterium. However, the agency put off approving Ketek for the far less serious diseases of acute bacterial sinusitis (common sinus infections) and... 

---