[Acute sinusitis in adults]

An average of 1.4% of the more than 30,000 participants in a treatment study were diagnosed as having acute sinusitis. 62% of all cases of sinusitis arose in patients aged between 15 and 44 years. Treatment with antibiotics is indicated in purulent sinusitis whilst non-purulent sinusitis is treated either with local or systemic antiphlogistic agents. The secondary bacterial infection is usually caused by Haemophilus influenzae, Streptococcus pneumoniae and anaerobic bacteria. In Scandinavia these probably account for 90% of the purulent sinusitis cases whilst Branhamella catarrhalis is responsible for the remaining 10%. Penicillin V is the agent of choice in acute sinusitis. Cefaclor is preferable in combatting H. influenzae. In a double blind study comparing doxycycline to cefaclor in the management of acute sinusitis (108 patients with cefaclor, 105 patients with doxycycline, no difference emerged between the two groups in the subjective assessment of the treatment results. Objective evaluation recorded excellent results for 88% and 83% of the patients in the cefaclor and doxycycline groups, respectively. Side-effects were noted by 7% of the cefaclor and by 13% of the doxycycline patients. The difference between the incidence of side-effects was not statistically significant. Taking into account the treatment results, the side-effects and ecological aspects, cefaclor is second only to penicillin as the agent of choice in suspected or confirmed purulent sinusitis (e. g. in presence of penicillin allergies or failure of the infection to respond to penicillin V).