Therapeutic approach to sinusitis: antiinfectious therapy as the baseline of management

Although acute sinusitis is an infectious disease in which several bacterial species play a major etiologic role, there is an important interaction between the respiratory viruses (common cold viruses) and the bacteria in the pathogenesis of acute community-acquired sinusitis. The relative inaccessibility of the sinus cavities makes special techniques of sampling necessary to acquire specimens that accurately reflect disease conditions in the sinuses. Bacterial etiology of sinus infection has therefore been determined by sinus puncture studies, chiefly of the maxillary sinus, several of which are reviewed here. Because the bacteria causing acute sinusitis have not changed in many years, puncture is not often necessary for clinical diagnosis. Patients with acute, community-acquired sinusitis can usually be treated empirically, on the basis of previous studies, unless complications are suspected. In that case, and in other patients with hospital-acquired sinusitis, puncture of the involved sinus and aspiration of sinus fluid for Gram's staining and quantitative microbial cultures and sensitivities are required for appropriate antimicrobial management.