title: A Surveillance Bacteriological Study of Acute Bacterial Rhinosinusitis in Thailand and the Clinical Responses to the Culture-directed Antibiotics.
abstract: OBJECTIVE
  To examine: 1) types of bacteria and antimicrobial sensitivity of commonly used antibiotics for acute bacterial rhinosinusitis (ABRS) in Thailand, 2) the effectiveness of using antibiotics according to antimicrobial sensitivity, and 3) the effectiveness of using antibiotics according to the Thai clinical practice guidelines (CPG) of ABRS.
  
  
  METHODS
  Descriptive & experimental studies were conducted in seven tertiary hospitals in Thailand. The specimens from maxillary sinuses were taken for bacterial cultures either by maxillary sinus tap or endoscopically directed middle meatus swabs in patients with clinically diagnosed ABRS. Antimicrobial sensitivity was performed and antibiotics were prescribed according to the results of antimicrobial sensitivity or the Thai CPG of ABRS.
  
  
  RESULTS
  A total of 113 patients were enrolled between August 2006 and April 2007, 104 cases of which were performed for bacteriological study. The incidence of bacterial growth was 60.6% (95% CI 51.0-69.4%). The most common bacteria was H. influenzae (25.0%, 95% CI 16.9-35.3%), followed by S. pneumoniae (14.3%, 95% CI 8.2-23.5%) and S. aureus (9.5%, 95% CI 4.7-17.9%), respectively, whilst M. catarrhalis was found only in 2.4% (95% CI 0.5-7.3%). Eight in 12 S. pneumoniae isolates were tested for the minimal inhibitory concentration of penicillin and found to be penicillin resistant strain in five specimens. Beta-lactamase producing H. influenzae was found in eight out of 20 isolates. H. influenzae had a tendency to be sensitive to amoxicillin/clavulanate, cefuroxime, cefpodoxime, azithromycin, clarithromycin, ofloxacin, levofloxacin and gatifloxacin, whilst S. pneumoniae had a tendency to be sensitive to amoxicillin/clavulanate, cefaclor ampicillin/sulbactam, cefuroxime, ofloxacin, levofloxacin, gatifloxacin, cefpodoxime, cefixime and cefdinir. The effectiveness of antibiotics prescription according to the Thai CPG of ABRS and antimicrobial sensitivity were comparable, 88.5% (95% CI 69.8-97.6%) and 82.2% (95% CI 67.9-92%), respectively.
  
  
  CONCLUSIONS
  H. influenzae is found to be the most common bacteria in Thai ABRS, followed by S. pneumoniae and S. aureus. There is a high incidence of beta-lactamase producing H. influenzae and penicillin non-susceptible S. pneumoniae.
authors.forename: Sanguansak
authors.initials: S
authors.lastname: Thanaviratananich
authors.forename: Supinda
authors.initials: S
authors.lastname: Chusakul
authors.forename: Greetha
authors.initials: G
authors.lastname: Moungthong
authors.forename: Thongchai
authors.initials: T
authors.lastname: Luxameechanporn
authors.forename: Pongsakorn
authors.initials: P
authors.lastname: Tantilipikorn
authors.forename: Supranee
authors.initials: S
authors.lastname: Fooanant
authors.forename: Songklot
authors.initials: S
authors.lastname: Aeumjaturapat
authors.forename: Pipat
authors.initials: P
authors.lastname: Sribenjalux
authors.forename: Nadtaya
authors.initials: N
authors.lastname: Makachen
authors.forename: Seksun
authors.initials: S
authors.lastname: Chainansamit
authors.forename: Saisawat
authors.initials: S
authors.lastname: Chaiyasate
authors.forename: Chaweewan
authors.initials: C
authors.lastname: Bunnag
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001431:Bacteriological Techniques; D006801:Humans; D015994:Incidence; D008826:Microbial Sensitivity Tests; D012220:Rhinitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D012852:Sinusitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D013785:Thailand / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents