Treatment of Sinusitis With Penicillin

Abstract

Cognizant of results being obtained in the treatment of streptococcic and staphylococcic infections with penicillin, we believed that this drug should also be effective in the therapy of certain types of sinusitis. During the past year we used penicillin in some of the many cases of suppurative sinus disease which came to our attention. It is desirable to describe at the very beginning the manner in which this study evolved and the experiences which eventually led us to employ penicillin in selected cases of suppuration of the paranasal sinuses. Because of the rather striking results which followed its use, we decided to report our observations in those cases in which penicillin was employed either alone or in conjunction with surgical treatment. Data were obtained which, we believe, enable us to begin to suggest the indications for its use in the treatment of suppuration of the sinuses. FIRST CASES IN WHICH PENICILLIN WAS TRIEDIn the first case in which we treated suppurative sinusitis with penicillin it produced a rapid and dramatic cure.A 27 year old aviation cadet suffered multiple frac¬ tures of the maxillas and nasal bones in an airplane crash. One month later a draining fistula developed immediately above the bridge of the nose. On Aug. S, 1943, fifty-eight days after the accident, this cadet came under our care. He still had at the glabella a drain¬ ing fistula through which a probe could be passed into the right frontal sinus, and pus was coming from the frontal and ethmoid sinuses bilaterally. Prior to coming to us, he had had intensive treatment with sulfonamide compounds without any apparent effect on the suppuration. While it was our opinion that a bilateral external frontoethmoidectomy would probably be required to eradicate the infection, we were reluc¬ tant to resort to this radical procedure because of the relatively short duration of the sinus disease. We treated him conservatively for nine weeks, adminis¬ tering local treatments to the nose, irrigating the sinus through the external fistula and then insufflating sulfanilamide powder-all without effect. Because cul¬ tures of the exúdate from the fistula revealed Strepto-coccus viridans, which proved to be penicillin sensitive in vitro, and since we had just received our first supply of penicillin, we decided to try it in this case. The penicillin was given intramuscu¬ larly, 10,000 units every three hours for six days and then 5,000 units every three hours for five days-a total of 695,000 units. After thirty-six hours of treatment the fistula was closed and there was only a minimal amount of exúdate in the nose. At the end of three days of treatment all discharge had disappeared, and it never recurred during the three months that he was kept under observation. Roentgenologic studies at the completion of the penicillin therapy showed clearing of the involved sinuses ( fig. 1 A).The second case in the trial series was that of a soldier who had a lifelong history of nasal allergy and purulent nasal discharge.There was pus on the floor of the nose a...

The Treatment of Maxillary Sinusitis by Local Injection of Procaine Penicillin-in-Oil

“…through Jn-dwelling needles. Putney (1944) and riest (1945) failed to relieve such cases with local irrigations, while auser and Work (1945), although successful with cases of subacute fections, were cautious in the interpretation of their small series of ises. Cardwell (1946) considered the method effective in a series of !…”