Bacterial sinusitis

Sinusitis is an inflammation and/or infection of the paranasal sinus mucosa. The term rhinosinusitis is used by some specialists, because sinusitis typically also involves the nasal mucosa. The majority of these infections are viral in origin. It is important to differentiate between viral and bacterial sinusitis to aid in optimizing treatment decisions. 

Bacterial sinusitis can be categorized into acute and chronic disease. Acute disease lasts less than 30 days with complete resolution of symptoms. Chronic sinusitis is defined as episodes of inflammation lasting more than 3 months with persistence of respiratory symptoms. 

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. 

The typical clinical presentation of bacterial sinusitis is presented in Table 44-8. 

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... 

Oral beta-lactam antibiotics such as amoxycillin, cotrimoxazole or doxycycline for 7-10 days are suitable for the treatment of bacterial sinusitis. Furuncles of the nose should be treated with an anti-staphyloccal drug for 5 days. Standard treatment for streptococcal pharyngitis consists of 10 days of penicillin. Malignant otitis externa responds to high dose quinolone therapy (e.g. ciprofloxacin 750 mg 2 t.d.) administered orally. For parapharyngeal abscess, high dose penicillin plus beta-lactamase inhibitors such as amoxycillin-clavulanic acid can be used. Duration of treatment is guided by clinical and parameters of inflammation, and abscesses often need several weeks to resolve by conservative treatment. 

Augmentin XR indicated for treatment of community-acquired pneumonia or bacterial sinusitis due to beta-lactamase-producing strains with reduced penicillin susceptibility... 

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

Bacterial sinusitis PO 500 mg once daily for 10 days or 750 mg once daily for 5 days. Bronchitis PO, IV 500 mg q24h for 7 days. 

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. 

Viral and bacterial sinusitis are difficult to differentiate because their clinical presentations are similar. Viral infections, however, tend to resolve by 7 to 10 days. Persistence of symptoms beyond this time likely indicates a bacterial infection. 

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

Viral sinusitis and bacterial sinusitis are difficult to differentiate because their clinical presentations are similar. Viral... 

Sinusitis is diagnosed more frequently in children than in adults. Typical clinical presentation and diagnosis of bacterial sinusitis are illustrated in Table 107-4. Between 5% and 13% of viral upper respiratory tract infections in children are complicated by bacte-... 

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