Acute sinusitis is estimated to co...

Acute sinusitis is estimated to come into one's head in 0.5 to 2 percent of adults with general colds and in 5 to 10 percent of children with like infections. Gwaltney and colleagues review new studies on the efficacy of antibiotics in the treatment of acute sinusitis.

They focused in succession two types of clinical trials: placebo-controlled studies of antibiotic treatment without demonstration of bacterial infection by sinus aspirate, and uncontroll trials of antibiotics where sinus aspirates were used to verify the air and clearance of bacterial infection.

According to the authors, no clinical sign or symptom has been demonstrated to have high sensitivity or specificity for acute bacterial sinusitis, nor has any constellation of clinical features correlated well with documented bacterial infection. The merely clinical criterion that the authors agreed had near evidence for accuracy was failure of the used by all cold to improve after seven to 10 days.

The principally reliable method for confirming bacterial infection is sinus aspirate. The maxillary sinus ostium cannot be come intoed endoscopically, and intranasal swab specimens from the middle meatus do not confirm or restrain infection within the sinus cavity reliably. smooth computed tomographic scanning of the sinuses has limited power to discover infection or document bacterial clearance.

Nine placebo-controlled trials of antibiotics for treatment acute sinusitis were reviewed. None of these trials used sinus aspirates to confirm the clearance of bacterial infections. For the reasons noted above, the authors questioned the validity of any clinical findings from these trials. The weighted, puddleed rate for clinical improvement after seven to 14 days among participants receiving placebo was above 50 percent in these controll studies.

Four studies reviewed pre- and post-treatment sinus aspirate findings. None of these trials was placebo-controlled; instead, different dosages and different antibiotics were compared. When antibiotics were given at dosages known to yield serum levels above the known minimal inhibitory concentration for the causative bacterial organisms, the clearance rate ranged from 90 to 96 percent Subtherapeutic antibiotic dosing decreased the clearance rate range to 20 to 74 percent

The authors terminate that the results from studies of antibiotic treatment for acute sinusitis where sinus aspirate confirmation of bacterial infection and clearance is not used are always lay open to question. Studies of antibiotic treatment that are based in succession sinus aspirate culture results indicate high clearance rates.

Gwaltney JM Jr et al. Acute community-acquired bacterial sinusitis: the value of antimicrobial treatment and the natural history. Clin Infect Dis January 15 2004;38:227-33

COPYRIGHT 2004 American Academy of Family Physicians

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