Sinusitis

Chronic rhiոοѕiոuѕitiѕ (CRS) is defined as a complex inflammatory condition involving the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer despite attempts at medical management. The diagnostic criteria for CRS are [1]

Acute exacerbation of СRS (AECRS) represents a sudden worsening of the baseline manifestations of СRЅ, which may involve new symptoms or an accentuation of existing symptoms. The acute, but not the chronic, symptoms typically resolve completely between occurrences.[1]

The microbiology of AECRS includes H. influenzae, S. pneumoniae, and M. catarrhalis, in addition to the organisms potentially associated with СRЅ (ie, аոаerоbeѕ, S. aureus, and gram-negative bacilli).[1]

This was demonstrated in a study in which serial endoscopic aspirations were performed in seven patients who had ≥3 episodes of maxillary AECRS per year, each lasting ≥10 days, with complete resolution of their acute symptoms between episodes. The patients were followed over a period of 125 to 242 days. [1]

The optimal duration of antimicrobial therapy is uncertain. When antibiotics are used for acute exacerbations of СRS, seven days is a reasonable duration. In patients who are slow to respond, the author of this topic sometimes uses longer therapy (eg, up to 21 days). [1]

If antibiotics are used for other situations when an infection is suspected and cannot be ruled out (eg, symptoms refractory to other anti-inflammatory measures), antibiotics are often given for two to four weeks. As above, use of antibiotics for this purpose is not universally endorsed.[1]

The evidence to support the duration recommendation is limited; only low-quality evidence supports the efficacy of antibiotics in the treatment of СRS, as above, and the duration of therapy has not been studied prospectively. Decisions on antibiotic duration in individual patients should weigh the uncertain benefit against the potential for adverse effects with prolonged therapy. [1]