Acute bacterial sinusitis in adults: management in the primary care setting.
Sinus disease is inherently associated with viral upper respiratory tract infections and occurs in 90% of individuals with the common cold. Acute bacterial sinusitis occurs in 0.5 to 2% of these individuals. Although the diagnosis of acute bacterial sinusitis is usually based on physical findings, no one sign or symptom is either sensitive or specific for sinusitis. The predictive power can be significantly improved when all signs and symptoms are combined into a clinical impression. Imaging studies have not been shown to be cost effective in the initial assessment and treatment of patients in the primary care setting. Simple plain films may be indicated to resolve the diagnosis in patients with an equivocal history or to follow patients admitted to hospital with severe sinus disease. The initial management of acute sinusitis should be directed toward the relief of symptoms with a 7-day course of decongestants and mucoevacuents. For patients who fail to improve with symptomatic treatment, a 10-day course of amoxicillin is recommended. Second line antibiotics should be initiated if improvement is not seen within 72 to 96 hours.
Desrosiers
Martin
M
McGill University Health Science Center, 1650 Cedar Ave, Room A2-141, McGill University, Montreal, QC.
Frenkiel
Saul
S
Hamid
Qutayba A
QA
Low
Don
D
Small
Peter
P
Carr
Stuart
S
Hawke
Michael
M
Kirkpatrick
David
D
Lavigne
François
F
Mandell
Lionel
L
Stevens
Holly E
HE
Weiss
Karl
K
Witterick
Ian J
IJ
Wright
Erin D
ED
Davidson
Ross
R
D000328:Adult; D000465:Algorithms; D000658:Amoxicillin / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D024881:Drug Resistance, Bacterial; D006801:Humans; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D012852:Sinusitis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D013256:Steroids; D014777:Virus Diseases / Q000175:diagnosis
D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D013256:Steroids; D000658:Amoxicillin