Acute maxillary sinusitis is a disease of varied etiology. Over half of the cases are caused by Streptococcus pneumoniae and Hemophilus influenzae. Anaerobic bacteria account for another 10% of cases and these are usually of dental origin. The rest of the cases are caused by several other bacteria, each of which cause a small proportion. Rhinoviruses, influenza, and parainfluenza viruses also in-vade the sinuses and probably lead to secondary bacterial infection. Diagnosis of acute sinusitis on clinical grounds is difficult. Sinus transillumination and x-ray are the most valuable routine tests available. Ampicillin, amoxicillin, trimethoprim-sulfamethoxazole, and cefaclor have been shown to be effective treatment for most cases of acute sinusitis. Infection persists when there is inadequate or inappropriate treatment. The patient may become relatively asymptomatic in the face of persistent active infection. Follow-up clinical and x-ray examinations are indicated, when possible, to detect treatment failures. Although not a routine diagnostic procedure, sinus puncture and aspiration may be of value in the seriously ill patient or one who has not responded to treatment.
Eighty-one adults with symptoms of acute sinusitis were studied by direct needle puncture and aspiration of the maxillary sinus (105 sinuses). Fifty-nine bacterial strains were isolated in titers of greater than or equal to 10(4) colony-forming units/ml; Streptococcus pneumoniae and Haemophilus influenzae accounted for 64% of the isolates. Other bacteria recovered included anaerobes (12%), Neisseria species (8.5%). Streptococcus pyogenes (3%), alpha-hemolytic Streptococcus (3%), non-group A beta-hemolytic Streptococcus (3%), Staphylococcus aureus (2%), Pseudomonas aeruginosa (2%), and Escherichia coli (2%). Viruses were isolated from 11 sinuses; these isolates included rhinovirus (six), influenza A (H3N2) virus (three), and two types of parainfluenza virus (one each). The efficacy of therapy with orally administered ampicillin, amoxicillin, or trimethoprim-sulfamethoxazole was evaluated by a repeat sinus puncture and culture. Clinical and bacteriologic responses to all three regimens were good.
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