Acute sinusitis

Case report:

A 42 year old woman appears in practice and complains of severe frontal headache, left upper jaw pain and a purulent discharge from the nose. This was preceded by a viral infection of the upper respiratory tract, although they subsided after a few days, however, the patient's symptoms had occurred for three days and a moderate fever up to 38.5 � C, it would have developed. As a child, had been manifest ever such an infection. Physical examination showed considerable pain-sensitive nerve exit points both in the area of the frontal sinus, as well as on the two maxillary sinuses. The inspection of the nose on both sides shows a significantly increased purulent secretion.

Comment:

Acute sinusitis is indeed primarily a childhood disease, but can be observed as sequelae of primary viral infections of the upper respiratory tract even in adulthood. Especially in patients with narrow nasal conditions or polyp formation and in poor drainage of the sinuses may occur after previous viral infections to bacterial superinfection.

Therapy:

In acute sinusitis a microbiological examination is not necessarily required because of careful puncture analyzes the microbiological etiology is relatively clear and uniform. As with otitis media are pneumococci, Haemophilus influenzae and Moraxella catarrhalis the leading pathogens, sometimes staphylococci and beta-hemolytic streptococci can be isolated. Not infrequently there is a mixed infection eg from pneumococci and Haemophilus influenzae. The decisive action at a sinusitis is the production and promotion of the secretion drainage eg with decongestant substances. Antibiotic therapy is definitely recommended in patients at risk (eg infants, patients with underlying medical conditions, elderly) as well as in moderate and severe clinical picture. The antibiotic therapy is based on the dominant pathogens mentioned. The most recommended substance is amoxicillin (Amoxypen others). This treatment should be replaced in the regions with higher ampicillin or amoxicillin resistance to Haemophilus influenzae and Moraxella, however due to a beta-lactamase formation by beta-lactamase stable antibiotic such as Amoxicillin-clavulanate (Augmentin), ampicillin-sulbactam (UNACID), cefaclor (PANORAL), cefuroxime axetil (ELOBACT, Zinnat), cefpodoxime proxetil (ORELOX, PODOMEXEF) or loracarbef (LORAFEM). A treatment duration of eight to ten days is recommended. A radiological examination of the paranasal sinuses is indicated only if hesitation or transition into a chronic disease. But has also proven the sonography of the maxillary sinus and frontal sinus.

Addition:

Over 90% of rhinosinusitis are primarily caused by viruses. The differentiation of viral from bacterial etiology is difficult one; in the current recommendations of three different and typical courses of bacterial rhinosinusitis are displayed. The leading pathogens are in adults and children unchanged pneumococci and Haemophilus influenzae, and Moraxella catarrhalis in adults also and rarely S.aureus. Due to the increased development of resistance of these germs is recommended as a drug of choice for bacterial origin for the empirical initial therapy Coamoxiclav (Augmentin, etc.). Secondarily pneumococcal effective fluoroquinolones such as levofloxacin (Tavanic) and moxifloxacin come (Avelox) and quite well doxycycline (various generics) into consideration.
Macrolide antibiotics, cotrimoxazole (various generics), clindamycin (SOBELIN etc.) and Oralcephalosporine are no longer considered sufficient effectively.
The additional symptomatic treatment should consist of nasal irrigation with saline, local steroid aerosols, antipyretics, analgesics and adequate hydration.