Acute community acquired bacterial sinusitis: To treat or not to treat

The paranasal sinuses, normally sterile, are prone to bacterial invasion as a complication of viral illnesses such as the common cold. Using computed tomograms, abnormalities of the sinuses can be seen in 90% of healthy adults with upper respiratory tract infections; only 2% of these patients will develop bacterial sinusitis. Possible rationales for antibiotic treatment of sinusitis include the normal sterility of the sinuses, the clinical morbidity associated with sinusitis, the possibility of serious intracranial and periorbital complications in untreated cases, and the possible progression of acute infections to chronic sinus disease. Evidence from the literature supports antibiotic treatment of sinusitis to eradicate infection and to reduce symptoms. There is insufficient literature evidence to prove that antibiotic treatment reduces serious complications or reduces progression to chronic sinus disease. Treatment should include an antimicrobial with a spectrum likely to cover the important pathogens, including those with high levels of resistance.