Source: C, Frei B, Zhanel G. Upper
Respiratory Tract Infections. In: DiPiro, JT, Talbert RL, Yee GC, Matzke
GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach.
8th ed. http://accesspharmacy.com/content.aspx?aid=8001906.
Accessed July 15, 2012.
- Inflammation and/or infection of paranasal sinus
- Acute: lasts
<30 days with complete resolution of symptoms.
- Chronic: episodes of inflammation lasting >3 months with persistence
of respiratory symptoms.
- Majority of cases viral
- Consider bacterial
infection if symptoms persist for ⩾7 days or become severe.
- Bacterial causes: S. pneumoniae and H. influenza
for ~70% of bacterial causes of acute sinusitis in both
adults and children.
- Acute bacterial sinusitis usually preceded by viral respiratory
tract infection that causes mucosal inflammation.
- Most cases have viral etiology yet antibiotics prescribed
for adults and children.
- Viral respiratory tract infection
- Nonspecific upper respiratory tract infection that persists
beyond 7–14 days
- Nasal discharge/congestion
- Maxillary tooth pain, facial or sinus pain
radiate (unilateral in particular)
- Deteriorates after initial improvement
- If severe or persists beyond 7 days, most likely bacterial
and should be treated with antimicrobials.
- Indications for antimicrobial therapy
- Nasal discharge and cough for >10–14 days or
- Severe signs and symptoms such as temperature 39°C
- Facial swelling or pain
- Similar symptoms as with acute sinusitis
but more nonspecific
- Rhinorrhea with acute exacerbations
- Chronic unproductive cough, laryngitis, and headache
- Chronic/recurrent infections occur 3–4 times
- Unresponsive to steam and decongestants.
Means of Confirmation
- Gold standard: Sinus puncture with recovery of bacteria
in high density
routinely performed since invasive procedure.
- Diagnosis based on clinical findings.
- Gram stain, culture, and sensitivities of draining fluid
or aspirated fluid if sinus puncture performed.
- Sinus radiography
- Not routinely used for
- Reduce signs and symptoms.
- Achieve and maintain patency of ostia.
- Limit antimicrobial treatment to those who may benefit.
- Eradicate bacterial infection with appropriate antimicrobial
- Minimize duration of illness.
- Prevent complications.
- Prevent progression from acute disease to chronic disease.
- Delineate viral and bacterial sinusitis.
on disease duration
- Viral: typically improves in
- Bacterial: persistent symptoms ⩾10 days or worsening of symptoms
after 5–7 days.
- Irrigation of nasal cavity with saline and steam inhalation
to increase mucosal moisture
- Mucolytics (e.g., guaifenesin) to decrease viscosity of nasal
- Nasal decongestant sprays such as phenylephrine and oxymetazoline
- Reduce inflammation by vasoconstriction
- Limit use to no more than 3 days to prevent rebound congestion.
- Oral decongestants may also aid in nasal or sinus patency.
- Avoid use of antihistamines.
- Amoxicillin first-line treatment for acute bacterial sinusitis.
Approach to treating acute bacterial sinusitis in Table 1. Dosing
guidelines in Table 2.
- Treat for 10–14
days, or at least 7 days after ...