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Antibiotic choice in acute and complicated sinusitis
S Mortimore1, P J Wormald, S Oliver
1Department of Otorhinolaryngology, Groote Schuur Hospital, Cape Town, South Africa.
The Journal of Laryngology and Otology
|June 13, 1998
Summary
This study analyzed acute complicated sinusitis microbiology in 87 patients. Streptococcus milleri and Haemophilus influenzae were common, while Streptococcus pneumoniae was notably absent, guiding appropriate antibiotic selection.
Area of Science:
- Otolaryngology
- Infectious Diseases
- Microbiology
Background:
- Acute sinusitis can lead to severe orbital, intracranial, soft tissue, or bony complications.
- Microbial etiology in complicated sinusitis is crucial for effective treatment strategies.
Purpose of the Study:
- To retrospectively analyze the microbiology of acute complicated sinusitis.
- To identify common pathogens and guide antimicrobial therapy for various complications.
Main Methods:
- Retrospective analysis of 87 hospitalized patients with acute sinusitis over five years.
- Microbiological analysis of sinus aspirates and empyema fluid.
- Review of surgical procedures and management of complications.
Main Results:
- Streptococcus milleri and Haemophilus influenzae were the most frequent isolates from sinus aspirates (44%).
- Streptococcus pneumoniae was infrequently isolated (10%).
- Intracranial and soft tissue/orbital empyemas predominantly featured Streptococcus milleri (50%) and Staphylococcus aureus (25%), with rare Haemophilus influenzae and Streptococcus pneumoniae.
Conclusions:
- Ampicillin is recommended for initial treatment of acute complicated sinusitis.
- Cloxacillin should be added for empyema cases.
- Chloramphenicol or ceftriaxone are indicated for intracranial complications.