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Antibacterials

Antimicrobial agents are frequently prescribed for both acute and chronic sinusitis. In many individuals, acute sinusitis is a self-limiting disease which spontaneously resolves without antibiotic treatments. Other individuals seek medical care from their primary care physicians for acute sinusitis, and are typically treated for seven to ten days with derivatives of penicillin, macrolides or erythromycin.

These antibiotics are moderately effective against non-hospital acquired Streptococcus pneumoniae and Haemonphilus influenzae bacteria, which are common disease causing agents in acute sinusitis. Such treatment may be complimented by oral decongestants, mucolytic agents (mucus thinning drugs), and decongestant nose sprays. The medical treatment of chronic sinusitis is more problematic. Such individuals have an underlying sinus disorder which is exacerbated by episodes of acute infection. In these individuals, we believe that treatment must be more than two weeks and include broad-spectrum antibiotics. This group of antibiotics includes the cephalosporins, quinolones and clarithromycins. 

Our treatment practice reflects the following: 1) the pathogenic (disease causing) bacteria are often different than those in acute infections, including Staphylococcus aureus and anaerobic bacteria. These microbials are often resistant to antibiotics which are effective for acute sinusitis, 2) the combination of mechanical obstruction of the communication of the sinuses to the nose and/or foci of longstanding infection within the sinuses impairs the efficacy of treatment, 3) the inflamed mucous membrane within infected sinuses can have an impaired blood supply and in such case, less antibiotic would reach the site of infection, and 4) patients with prior surgery should be assumed to have compromised blood flow to the operated sinus.

References

Gillespie MB, O'Malley BW Jr, Francis HW. An approach to fulminant invasive fungal rhinosinusitis in the immunocompromised host.Arch Otolaryngol Head Neck Surg. 1998;124:520-6.

Malani PN, Kauffman CA. Invasive and Allergic Fungal Sinusitis. Curr Infect Dis Rep. 2002;4:225-232

Manning SC, Mabry RL, Schaefer SD.Evidence of IgE-mediated hypersensitivity in allergic fungal sinusitis. Laryngoscope. 1993;103:717-21.

Ponikau JU, Sherris DA, , Kita H, Kern EB. Intranasal antifungal treatment in 51 patients with chronic rhinosinusitis. J Allergy Clin Immunol. 2002;110:862-866. 

Ponikau JU, Sherris DA, Kephart GM, Kern EB, Gaffey TA, Tarara JE, Kita H..Features of airway remodeling and eosinophilic inflammation in chronic rhinosinusitis: is the histopathology similar to asthma? J Allergy Clin Immunol. 2003;112:877-82.

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