Studies of Acute Maxillary Sinusitis in Adults

At least four studies have examined SCAT for the treatment of acute maxillary sinusitis in adults (36). Williams and coworkers carried out a randomized trial of 80 adults with acute maxillary sinusitis treated with 3 versus 10 days of trimetho-prim-sulfamethoxazole (TMP-SMX) and reported 76% cure rates and bacteriologic eradication in both groups. The authors concluded that afebrile, immunocompe-tent adults could receive a 3-day course of TMP-SMX. Nonresponders should be re-evaluated and treated for 10 days (36). Casiano and coworkers performed a study of acute maxillary sinusitis in 78 adults treated with azithromycin 500 mg on day 1 followed by 4 days of 250 mg compared to those with amoxicillin 500 mg three times daily for 10 days (37). Clinical diagnosis was confirmed by transantral maxillary sinus aspiration. Bacteriologic cure was reported as 100% in each group and clinical cure was 74% and 73%, respectively. Khong and coworkers evaluated 386 patients randomized to cefpodoxime proxetil for 5 days versus amoxicillin/ clavulanic acid for 8 days (38). Clinical cure rates were 83% and 86%, respectively.

Guidelines from the Sinus and Allergy Health Partnership suggest stratifying patients by severity of disease, rate of progression, and prior treatment with antibiotics (39). Traditionally, the duration of therapy for acute bacterial rhinosinu-sitis has been 7 to 14 days. In the controlled studies discussed, SCAT for fewer than 7 days was equivalent to longer courses. Risk factors for failure in the SCAT group included a history of more than 4 episodes of sinusitis over a 2-year period and a history of surgical drainage. Longer treatment courses may be beneficial for these groups and non-responders to initial therapy.

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