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A study to examine the effectiveness of antibiotics and topical nasal steroids in treatment of acute sinusitis is presented. Results conclude that neither antibiotics nor nasal steroids nor a combination of the two was effective in the treatment of acute sinusitis in the primary care setting.

Acanthamoeba infection is a rare, difficult-to-treat, and often fatal, opportunistic parasitic infection in immunocompromised hosts, such as patients infected with HIV. We describe an aggressive nasal and sinus infection by Acanthamoeba spp. in a person with AIDS. The resolution of this Acanthamoeba infection was secondary to a multidisciplinary treatment approach involving a combination of surgery as well as high-dose amphotericin B plus 5-fluorocytosine. In the era of the HIV/AIDS pandemic, the present report underscores the need for early identification and prompt aggressive treatment to ensure successful management of this rare but potentially fatal opportunistic infection.

The American Academy of Pediatrics, evidence-based guidelines endorse the use of cephalosporin antibiotics for patients with reported allergies to penicillin, for the treatment of acute bacterial sinusitis and acute otitis media. Many physicians, however, remain reluctant to prescribe such agents. Although such concern is understandable, lack of consistent data regarding exactly what constitutes an initial penicillin-allergic reaction and subsequent cross-sensitivity to cephalosporins may be preventing many patients from receiving optimal antibiotic therapy. This article reviews evidence in support of the American Academy of Pediatrics recommendation. Included is an examination of the types and incidence of reactions to penicillins and cephalosporins; the frequency of cross-reactivity between these 2 groups of agents; experimental and clinical studies that suggest that side chain-specific antibodies predominate in the immune response to cephalosporins, thereby explaining the lack of cross-sensitivity between most cephalosporins and penicillins; the role of skin testing; and the risks of anaphylaxis. Specific recommendations for the treatment of patients on the basis of their responses to previously prescribed agents are summarized. Pediatrics 2005;115:1048-1057; penicillin, cephalosporin, allergy., ABBREVIATION. AAP, American Academy of Pediatrics. The American Academy of Pediatrics (AAP) practice guidelines for the management of acute bacterial sinusitis (1) endorse the use of selected second-generation and third-generation [...]

Adding an inhaled corticosteroid to antibiotic therapy may be beneficial in treating sinus infections, according to a study of 88 patients. In this study, inhaled fluticasone was compared to a placebo and all patients received xylometazoline and cefuroxime., Context: It is not known whether intranasal corticosteroids are beneficial to treat acute rhinosinusitis in patients with a history of chronic or recurrent sinus symptoms. Objective: To assess whether the addition of an intranasal corticosteroid to antibiotic therapy affects the speed and rate of recovery of such patients with acute rhinosinusitis. Design, Setting, and Patients: A double-blind, randomized, placebo-controlled multicenter trial of 95 patients (median age, 39 years) with a history of recurrent sinusitis or chronic rhinitis and evidence of acute infection by sinus radiograph or nasal endoscopy, which was conducted from October 1998 through April 2000 at 22 sites (12 primary care and 10 otolaryngology). Intervention: Two puffs (total dose, 200 [micro]g) of fluticasone propionate (n=47) or placebo nasal spray (n=48) in each nostril once daily for 21 days; all received 2 puffs of xylometazoline hydrochloride in each nostril twice daily for 3 days and 250 mg of cefuroxime axetil twice daily for 10 days. Main Outcome Measure: Time to clinical success (patient reported cured or much improved) during telephone follow-up at 10, 21, and 56 days. Results: A total of 88 patients (93%) completed follow-up. Patients recorded their symptoms, work assessment, and compliance during the 3-week treatment phase. Patients receiving fluticasone achieved a significantly higher rate of clinical success than patients receiving placebo (93.5% vs 73.9%; P=.009). Patients treated with fluticasone improved significantly more rapidly (median of 6.0 days to clinical success) vs patients in the placebo group (median of 9.5 days; P=.01). Conclusions: The addition of fluticasone to xylometazoline and antimicrobial therapy with cefuroxime improves clinical success rates and accelerates recovery of patients with a history of chronic rhinitis or recurrent sinusitis who present for treatment of acute rhinosinusitis.

Distinguishing bacterial sinusitis from that caused by viral infection is critical to avoid the unnecessary use of antibiotics. Clinical diagnosis should be made on the basis of symptoms persisting for greater than 10 to 14 days, or severe symptoms including fever and facial pain and swelling. Abnormal radiographic imaging, or X-rays, cannot distinguish between viral, bacterial, or allergic causes for sinus inflammation, and should be interpreted with caution. Narrow-spectrum antibiotic therapy, when indicated, should be limited to 7 days after symptoms improve., Establishing an accurate diagnosis of bacterial sinusitis is challenging but critical, because viral rhinosinusitis is at least 20 to 200 times more common than bacterial infection of the sinuses. Strict criteria for clinical diagnosis that require either prolonged and persistent symptoms or an acute severe presentation are supported with published evidence. Radiographic imaging of the sinuses should be used only in very selected circumstances. A majority of patients with the common cold will meet radiographic criteria for sinusitis early in the course of their illness. For patients meeting these strict criteria, an appropriate narrow-spectrum antimicrobial agent will be of modest benefit compared with symptomatic treatment alone. Pediatrics 1998;101:174-177; sinusitis, diagnosis, antimicrobial therapy, mucopurulent rhinitis, antimicrobial resistance, pediatrics., ABBREVIATIONS. URI, upper respiratory tract illness; CT, computed tomography. PRINCIPLES 1. Clinical diagnosis of bacterial sinusitis requires the following: prolonged nonspecific upper respiratory signs and symptoms (ie, rhinosinusitis and cough [...]

A three-day course of the antibiotic trimethoprim-sulfamethoxazole appears to be as effective as a 10-day regimen in treating patients with sinus inflammation. Researchers treated 76 men who had sinus inflammation with a nasal decongestant and two daily doses of 160 milligrams (mg) of trimethoprim and 800 mg of sulfamethoxazole. Thirty-nine men took the antibiotic for three days while 37 men took the drug for 10 days. Symptoms of sinus inflammation significantly improved or were cured in a median of five days in patients on the three-day regimen and 4.5 days in those on the 10-day regimen. After two weeks of treatment, symptoms had significantly improved or resolved in 77% of patients on the three-day regimen and 76% on the 10-day regimen. Of these, 11% of patients in the 3-day treatment group and 4% in the 10-day treatment group relapsed within 30 days and 4% in both groups had a recurrence within 60 days., Objective.--To compare 14-day outcomes and relapse and recurrence rates among patients with acute maxillary sinusitis randomized to 3-day (3D) vs 1 0-day (10D) treatment with trimethopfim/sulfamethoxazole (TMP/SMX). Setting.--University-affiliated Veterans Affairs general medical and acute care clinics. Patients.--Consecutive patients with sinus symptoms and radiographic evidence of maxillary sinusitis (complete opacity, air-fluid level, or -6 mm of mucosal thickening). Patients were excluded for antibiotic use within the past week, TMP/ SMX allergy, symptoms for more than 30 days, or previous sinus surgery. Methods.-all subjects (n=80) received oxymetazoline nasal spray 0.05%, two sprays twice daily for 3 days. Subjects were randomly assigned to TMP/SMX double strength: one tablet twice daily for 1 0 days or one tablet twice daily for 3 days followed by 7 days of placebo. At 7 and 14 days, patients rated their overall sinus symptoms on a Likert scale. Radiographs were scored at baseline and 14 days by radiologists masked to clinical symptoms and treatment assignment. The primary outcome was number of days to "cure" or "much improvement" in sinus symptoms. Patients who were clinical successes by day 14 were assessed for symptomatic relapse or recurrence at 30 and 60 days, respectively. Results.--Groups were comparable at randomization: male, 1 00%; black, 53%; median age, 48 years (interquartile range, 41 to 63 years); symptom duration, 10 days (interquartile range, 6 to 17 days); bilateral maxillary disease, 51%; and radiograph score, 4 (interquartile range, 2 to 4). Outcome assessment was completed in 95% of patients at day 14 (n=76). Medication side effects and use of nonstudy sinus medications were equal between groups. By 14 days, 77% of 3D subjects and 76% of 10D subjects rated their sinus symptoms as cured or much improved (95% confidence interval for difference, -15% to 17%). Median days to cure/much improvement were 5.0 and 4.5 for the 3D and 10D groups, respectively; distributions of time to cure were not different (P=.34). Radiograph scores improved in both groups compared with baseline (2 points; P

Older, less expensive antibiotics are as effective as newer, more expensive antibiotics in treating simple cases of sinus infection. This was the conclusion of researchers who evaluated 17 different antibiotics in a study of 29,102 patients with a sinus infection.