title: Acute bacterial sinusitis in adults: management in the primary care setting.
abstract: 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.
authors.affiliation: McGill University Health Science Center, 1650 Cedar Ave, Room A2-141, McGill University, Montreal, QC.
authors.forename: Martin
authors.initials: M
authors.lastname: Desrosiers
authors.forename: Saul
authors.initials: S
authors.lastname: Frenkiel
authors.forename: Qutayba A
authors.initials: QA
authors.lastname: Hamid
authors.forename: Don
authors.initials: D
authors.lastname: Low
authors.forename: Peter
authors.initials: P
authors.lastname: Small
authors.forename: Stuart
authors.initials: S
authors.lastname: Carr
authors.forename: Michael
authors.initials: M
authors.lastname: Hawke
authors.forename: David
authors.initials: D
authors.lastname: Kirkpatrick
authors.forename: François
authors.initials: F
authors.lastname: Lavigne
authors.forename: Lionel
authors.initials: L
authors.lastname: Mandell
authors.forename: Holly E
authors.initials: HE
authors.lastname: Stevens
authors.forename: Karl
authors.initials: K
authors.lastname: Weiss
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Witterick
authors.forename: Erin D
authors.initials: ED
authors.lastname: Wright
authors.forename: Ross
authors.initials: R
authors.lastname: Davidson
mesh_terms: 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
chemical_list: D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D013256:Steroids; D000658:Amoxicillin