Acute Community-Acquired Bacterial Sinusitis: Continuing Challenges and Current Management

Abstract

Acute sinusitis is one of the most common infections seen in general clinical practice. The most common cause of acute sinusitis is viral; however, many patients receive a prescription for an antibiotic. Such injudicious prescribing habits have a major impact on health care costs, contribute to the increasing prevalence of drug-resistant strains of common respiratory pathogens, and reflect many of the challenges in differentiating viral and bacterial disease. Sinus puncture and culture of the aspirate, the diagnostic reference standard in the research setting, are not appropriate for routine clinical practice. However, certain clinical signs and symptoms that do not improve or that worsen after 7-10 days are currently accepted criteria for diagnosis of bacterial sinusitis. Accurate diagnosis can select patients who would benefit most from antimicrobial use. Antimicrobial agents should be selected on the basis of local resistance patterns, and their spectrum of activity should cover the common bacterial pathogens, including resistant strains.

Allergic rhinitis-induced nasal congestion: its impact on sleep quality

“…109 Most patients with symptoms of acute rhinosinusitis are treated with antibiotics; however, the viral nature of most rhinosinusitis infections suggest that antibiotics may be overused. 110,111 Patients with chronic rhinosinusitis, and chronic rhinosinusitis with nasal polyposis, commonly present with nasal obstruction, nasal discharge, facial pressure, pain, and hyposmia of prolonged duration. 112 Recent evidence suggests that chronic rhinosinusitis and chronic rhinosinusitis with nasal polyposis are distinct entities with separate inflammatory pathways and cytokine profiles.…”

Microbiology Aspects of Rhinosinusitis

“…Viral rhinosinusitis results in the loss of ciliated cells and mucociliary flow during the first week of infection. Consequently, the impaired mucociliary function during viral rhinosinusitis increases the risk of bacterial superinfection, which, in turn, results in further disruption of mucociliary flow ( Fokkens et al, 2007;Sande & Gwaltney 2004). Exposure to bacterial toxins can also reduce ciliary function.…”

“…It is usually a secondary infection resulting from ostiomeatal complex obstruction, impaired (delayed or absent) mucociliary clearance and weakened mucociliary integrity caused by an acute viral upper respiratory tract infection (Sande & Gwaltney, 2004).…”

High costs and burden of illness in acute rhinosinusitis: real-life treatment patterns and outcomes in Swedish primary care

“…In 2000 the direct costs in the United States were estimated to be nearly $6 billion. 2,3 According to current European guidelines, the recommended treatment for mild acute rhinosinusitis is symptomatic, with nasal steroids advised in moderate cases. 4,5 Antibiotics should only be added if severe symptoms are present (e.g.…”