Acute Bacterial Rhinosinusitis
in Adults: Part II. Treatment
DEWEY C. SCHEID, M.D., M.P.H., and ROBERT. M. HAMM, PH.D.
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Although most cases of acute rhinosinusitis are caused by viruses,
acute bacterial rhinosinusitis is a fairly common complication.
Even though most patients with acute rhinosinusitis recover promptly
without it, antibiotic therapy should be considered in patients
with prolonged or more severe symptoms. To avoid the emergence and
spread of antibiotic-resistant bacteria, narrow-spectrum antibiotics
such as amoxicillin should be used for 10 to 14 days. In patients
with mild disease who have beta-lactam allergy, trimethoprim / sulfamethoxazole
or doxycycline are options.
Second-line antibiotics should be considered if the patient has
moderate disease, recent antibiotic use (past six weeks), or no
response to treatment within 72 hours. Amoxicillin-clavulanate potassium
and fluoroquinolones have the best coverage for Haemophilus influenzae
and Streptococcus pneumoniae. In patients with beta-lactam hypersensitivity
who have moderate disease, a fluoroquinolone should be prescribed.
The evidence supporting the use of ancillary treatments is limited.
Decongestants often are recommended, and there is some evidence
to support their use, although topical decongestants should not
be used for more than three days to avoid rebound congestion.
Topical ipratropium and the sedating antihistamines have anticholinergic
effects that may be beneficial, but there are no clinical studies
supporting this possibility. Nasal irrigation with hypertonic and
normal saline has been beneficial in chronic sinusitis and has no
serious adverse effects. Nasal corticosteroids also may be beneficial
in treating chronic sinusitis. Mist, zinc salt lozenges, echinacea
extract, and vitamin C have no proven benefit in the treatment of
acute bacterial rhinosinusitis. (Am Fam Physician 2004;70:1697-704,1711-12.
Copyright© 2004 American Academy of Family Physicians.)
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