Acute Sinusitis

Acute bacterial rhinosinusitis is a common upper respiratory tract infection, with more than 20 million cases reported annually in the United States (6). Many of these infections are associated with viral illnesses that are occasionally complicated by bacterial superinfection. Data suggest that only about 2% of patients with viral sinusitis develop clinically significant bacterial superinfection.

Common presenting signs and symptoms include facial pain, headache, nasal discharge, and fever. It is generally believed that patients with acute symptoms (< 7 days) are unlikely to have bacterial infection. Distinguishing between viral and bacterial etiologies and the ability to isolate a specific pathogen are difficult.

Acute bacterial sinusitis is often caused by pneumococci, Haemophilus spp., or S. aureus, and many infections are mixed. Chronic infections also may be caused by S. aureus, anaerobic bacteria, or aerobic Gram-negative bacilli. Frequent antibiotic exposure increases the risk of MDR pathogens, anaerobic bacteria, and opportunistic pathogens. The specific antibiotics prescribed should be based on the prevalence of antibiotic resistant organisms and prior antibiotic use within the past 3 to 6 months.

Optimal duration of therapy for acute bacterial sinusitis has not been well-defined, but most textbooks recommend a 7- to 14-day course (6,28). Problems include the uncertainty of diagnosis using clinical assessment, radiography, ultrasound or computerized tomography, and difficulty differentiating bacterial sinusitis from viral or allergic rhinitis. In addition, most studies have involved acute maxillary sinusitis and it is not clear that these data can be applied to frontal, ethmoid, and sphenoid sinusitis.

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