Click here to view next page of this article
SinusitisSinusitis affects 12% of adults and complicates 0.5% of viral upper respiratory infections. Symptoms that have been present for less than 1 month are indicative of acute sinusitis, while symptoms of longer duration reflect chronic sinusitis. Pathophysiology Factors that predispose to sinus infection include anatomic abnormalities, viral URIs, allergies, overuse of topical decongestants, asthma. Acute sinusitis is associated with the same bacteria as otitis media. Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis are the most commonly encountered pathogens. Clinical Evaluation If symptoms have lasted for less than 7 sinusitis to 10 days and the patient is recovering, a self-limited viral URI is the most likely sinusitis cause. However, worsening symptoms or symptoms. High fever and signs of acute toxicity are unusual except in the most severe cases. Purulent drainage in the patient's nose or throat. The nasal mucosa is often erythematous Sinusitis and swollen. The presence of mucopus in the external nares. Laboratory Evaluation Imaging. Plain films are usually unnecessary for evaluating acute sinusitis because of the high cost and relative insensitivity. CT scanning is useful if the diagnosis remains uncertain or if orbital or intracranial complications are suspected. CT scanning is nonspecific and may demonstrate sinus abnormalities in 87% of patients with Sinusitis colds (not sinusitis). MRI is useful when fungal Sinusitis infections or tumors are seriously considered. Sinus aspiration is an invasive Sinusitis procedure, and is only indicated for complicated sinusitis, immunocompromise, failure to respond to multiple courses of empiric antibiotic therapy. Management of Sinusitis Antibiotic Therapy for Sinusitis Amoxicillin is first-line therapy in patients who are not allergic to penicillin. Trimethoprim-sulfamethoxazole is an alternative for penicillin-allergic patients. A 2-3 week course of therapy is recommended; however, if the patient is improved but still symptomatic at the end of the course, the medication should be continued for an additional 5 to 7 days after symptoms subside. First-line Agents Amoxicillin (Amoxil): Adults, 500 mg tid orally for 14 days. Children, 40 mg/kg/d in 3 divided doses. Trimethoprim/sulfamethoxazole (Bactrim, Septra): Adults, 1 DS tab (160/800 mg) bid. Children, 8/40 mg/kg/d bid. Erythromycin/sulfisoxazole (Pediazole): Children, 50/150 mg/kg/d qid. Broader-Spectrum Agents If the initial response to antibiotics is unsatisfactory, beta-lactamase-producing bacteria are likely to be present, and broad-spectrum therapy is |