eMedicine Specialties > Infectious Diseases > HEENT Infections
Sinusitis, Acute: Treatment & Medication
Updated: Feb 10, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
The goals of therapy in rhinosinusitis are to improve mucociliary function and to control infection.
Surgical Care
Antral puncture and irrigation are used for diagnostic culture and sensitivity testing in immunosuppressed or critically ill patients if the organism must be identified. However, more recent data support the role of endoscopically guided middle meatus cultures instead.
Consultations
- Ear, nose, and throat specialist for complications or when routine management techniques fail
- Infectious disease specialist in complicated cases
Medication
Viral rhinosinusitis does not require antimicrobial treatment.
Standard nonantimicrobial treatment options include topical steroids, topical and/or oral decongestants, mucolytics, and intranasal saline spray.
A recent meta-analysis of 4 double-blind, placebo-controlled trials of intranasal corticosteroid treatment in acute rhinosinusitis supports its use as monotherapy or as an adjuvant therapy to antibiotics.11 However, a recent randomized controlled trial of antibiotics and intranasal steroid showed no treatment benefit of intranasal steroids, either alone or with antibiotics.12
Ahovuo-Saloranta et al, in a 2008 Cochrane Review meta-analysis of 57 studies, concluded that antibiotics yield a small treatment effect in a primary care setting in patients with uncomplicated sinusitis whose symptoms have lasted more than 7 days.13 However, another meta-analysis found no treatment effect of antibiotics, even in patients whose symptoms had persisted for more than 10 days.14
No available data suggest that antihistamines are beneficial in acute sinusitis. In fact, antihistamines may cause harm by drying mucous membranes and decreasing clearance of secretions.
Antibiotics
Antibiotic efficacy rates are as follows:
- Levofloxacin, moxifloxacin, and amoxicillin/clavulanate - Greater than 90%
- High-dose amoxicillin, cefpodoxime proxetil, cefixime, cefuroxime axetil, and trimethoprim-sulfamethoxazole - 80-90%
- Clindamycin, doxycycline, cefprozil, azithromycin, clarithromycin, and erythromycin - 70-80%
- Cefaclor and loracarbef - 50-60%
Based on the 2000 Sinus and Allergy Health Partnership treatment guidelines for acute bacterial rhinosinusitis, patients are divided into 3 groups, as follows:
- Adults with mild disease who have not received antibiotics: Amoxicillin/clavulanate, amoxicillin (1.5-3.5 g/d), cefpodoxime proxetil, or cefuroxime is recommended as initial therapy.
- Adults with mild disease who have had antibiotics in the previous 4-6 weeks and adults with moderate disease: Amoxicillin/clavulanate, amoxicillin (3-3.5 g), cefpodoxime proxetil, or cefixime is recommended.
- Adults with moderate disease who have received antibiotics in the previous 4-6 weeks: Amoxicillin/clavulanate, levofloxacin, moxifloxacin, or doxycycline is recommended.
Patients who remain symptomatic despite appropriate antibiotic therapy may be evaluated with sinus endoscopy, CT scanning, or sinus aspiration/culture.
Amoxicillin (Amoxil, Trimox)
First-line antibiotic choice. Interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria.
Adult
250 mg PO q8h for 10-12 d
Pediatric
Not established
Reduces efficacy of oral contraceptives
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment; use during mononucleosis produces a characteristic rash
Penicillin V potassium (Beepen-VK, Pen-Vee K)
First-line antibiotic choice. Inhibits biosynthesis of cell wall mucopeptide. Bactericidal against sensitive organisms when adequate concentrations are reached and most effective during stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects.
Adult
250 mg PO q6h for 10-12 d
Pediatric
Not established
Probenecid may increase effectiveness by decreasing clearance; tetracyclines are bacteriostatic, causing a decrease in effectiveness when administered concurrently
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in renal impairment; superinfections may occur with prolonged use; reduces efficacy of oral contraceptives
Erythromycin (E.E.S., E-Mycin, Eryc)
First-line treatment in patients allergic to penicillin. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Adult
250 mg PO q6h for 10-12 d
Pediatric
Not established
Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, benzodiazepines, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis; may prolong QT interval, resulting in cardiac arrest if combined with nonsedating antihistamines
Documented hypersensitivity; hepatic impairment
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in liver disease; estolate formulation may cause cholestatic jaundice; adverse GI effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur
Trimethoprim and sulfamethoxazole (Bactrim DS, Septra)
First-line agent with more convenient dosing. Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid.
Adult
160 mg TMP/800 mg SMZ PO q12h for 10-12 d
Pediatric
<2 months: Do not administer
>2 months: Not established
May increase PT when used with warfarin (perform coagulation tests, and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases incidence of thrombocytopenia purpura in elderly persons; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase levels of zidovudine
Documented hypersensitivity; megaloblastic anemia due to folate deficiency
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Discontinue at first appearance of skin rash or sign of adverse reaction; obtain CBC counts frequently; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, give 5-15 mg/d leucovorin); caution in folate deficiency (eg, people with long-term alcoholism, elderly people, those receiving anticonvulsant therapy, those with malabsorption syndrome); hemolysis may occur in G-6-PD deficiency; patients with AIDS may not tolerate or respond to TMP-SMZ; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); give fluids to prevent crystalluria and stone formation
Cefprozil (Cefzil)
Second-line agent. Binds to one or more of the penicillin-binding proteins, which, in turn, inhibits cell wall synthesis and results in bactericidal activity.
Adult
250-500 mg PO q12h for 10 d
Pediatric
Not established
Probenecid increases effect; coadministration with furosemide and aminoglycosides increases nephrotoxic effects
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy
Cefuroxime (Ceftin)
Second-line agent. Second-generation cephalosporin maintains gram-positive activity of first-generation cephalosporins. Adds activity against Proteus mirabilis, H influenzae, Escherichia coli, Klebsiella pneumoniae, and M catarrhalis.
Adult
250 mg PO bid for 10 d
Pediatric
Not established
Disulfiramlike reactions may occur when alcohol is consumed within 72 h after taking cefuroxime; may increase hypoprothrombinemic effects of anticoagulants; may increase nephrotoxicity in patients receiving potent diuretics such as loop diuretics; coadministration with aminoglycosides increases nephrotoxic potential; concomitant use with agents that lower gastric pH decreases absorption
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Reduce dosage by half if CrCl is 10-30 mL/min and by three fourths if <10 mL/min (high doses may cause CNS toxicity); bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy
Cefpodoxime (Vantin)
Second-line agent. Binds to one or more penicillin-binding proteins, which, in turn, inhibits cell wall synthesis and results in bactericidal activity.
Adult
100 mg PO q12h for 10 d
Pediatric
Not established
Probenecid increases effect; coadministration with furosemide and aminoglycosides increases nephrotoxic effects; antacids and H2 blockers decrease absorption
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Reduce dosage by half if CrCl is 10-30 mL/min and by three fourths if <10 mL/min (high doses may cause CNS toxicity); bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy
Cefixime (Suprax)
Second-line agent. By binding to one or more penicillin-binding proteins, arrests bacterial cell wall synthesis and inhibits bacterial growth.
Adult
400 mg PO qd for 10 d
Pediatric
Not established
Increases carbamazepine levels; coadministration of aminoglycosides increases nephrotoxicity; probenecid may increase effects
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy
Amoxicillin and clavulanate (Augmentin)
Second-line agent. Drug combination treats bacteria resistant to beta-lactam antibiotics.
Adult
875 mg PO q12h or 500 mg PO q8h for 10 d
Pediatric
Not established
Coadministration with warfarin or heparin increases risk of bleeding
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Presence of mononucleosis produces skin rash; interstitial nephritis and renal failure may occur in high doses
Clarithromycin (Biaxin)
Second-line agent. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Adult
500 mg PO bid for 10 d
Pediatric
Not established
Toxicity increases with coadministration of fluconazole, astemizole, and pimozide; effects decrease and adverse GI effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, omeprazole, carbamazepine, ergot alkaloids, triazolam, and HMG CoA-reductase inhibitors; serious cardiac arrhythmia may occur with coadministration of cisapride; plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmia and increase in QT intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both agents
Documented hypersensitivity; coadministration of pimozide or cisapride
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Coadministration with ranitidine or bismuth citrate is not recommended with CrCl <25 mL/min; give half dose or increase dosing interval if CrCl <30 mL/min; diarrhea may be sign of pseudomembranous colitis; superinfections may occur with prolonged or repeated antibiotic therapies
Levofloxacin (Levaquin)
Used to treat acute maxillary sinusitis caused by S pneumoniae, H influenzae, or M catarrhalis. Fluoroquinolones should be used empirically in patients likely to develop exacerbation due to resistant organisms to other antibiotics. This is the L stereoisomer of the D/L parent compound ofloxacin, the D form being inactive. Good monotherapy with extended coverage against Pseudomonas species, as well as excellent activity against pneumococcus. Agent acts by inhibition of DNA gyrase activity. PO form has bioavailability that is reportedly 99%.
Adult
500 mg PO qd for 7-14 d
Pediatric
<18 years: Not recommended
>18 years: Administer as in adults
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; reduces therapeutic effects of phenytoin; probenecid may increase serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy
Doxycycline (Periostat, Doryx, Bio-Tab, Vibramycin Vibra-tabs)
Inhibits protein synthesis, and thus bacterial growth, by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.
Adult
100-200 mg PO bid for 14 d
Pediatric
<8 years: Not recommended
>8 years: 2-5 mg/kg/d PO in 1-2 divided doses; not to exceed 200 mg/d
Bioavailability decreases with antacids that contain aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy
Documented hypersensitivity; severe hepatic dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines
Topical decongestants
These agents cause vasoconstriction, which reduces nasal congestion.
Phenylephrine (Neo-Synephrine)
Produces vasoconstriction. Possibly helpful, not harmful.
Adult
2 puffs q4h prn; not to exceed 3 d of use
Pediatric
Not established
May cause hypertensive crisis in the presence of MAOIs
Documented hypersensitivity; severe hypertension or ventricular tachycardia
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Prolonged use may produce rhinitis medicamentosa; caution in hypertension
Oxymetazoline (Afrin)
Applied directly to mucous membranes. Stimulates alpha-adrenergic receptors and causes vasoconstriction. Decongestion occurs without drastic changes in blood pressure, vascular redistribution, or cardiac stimulation.
Adult
2 puffs in each nostril bid; not to exceed 3 d of use
Pediatric
Not established
Hypotensive action of guanethidine may be reversed; concurrent administration with methyldopa may result in increased vasopressor response; concurrent use of MAOIs and ephedrine may result in hypertensive crisis; pressor sensitivity to mixed-acting agents, such as ephedrine, may be increased; guanethidine potentiates effects of epinephrine and inhibits effects of ephedrine; phenothiazines may reverse action of nasal decongestants; TCAs potentiate vasopressor response and may result in dysrhythmia
Documented hypersensitivity; MAOI therapy; angle-closure glaucoma
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in hyperthyroidism, coronary artery and ischemic heart disease, diabetes mellitus, increased intraocular pressure, or prostatic hypertrophy; because of increase in vasoconstriction, patients who are hypertensive may experience change in blood pressure; may produce rhinitis medicamentosa
Guaifenesin (Anti-Tuss, Humibid LA, Robitussin)
Increases respiratory tract fluid secretions and helps to loosen phlegm and bronchial secretions. Indicated for patients with bronchiectasis complicated by tenacious mucous and/or mucous plugs.
Adult
600-mg SR tab 1-2 tab PO q12h
Pediatric
<2 years: Not recommended
2-6 years: One-half tab PO q12h
6-12 years: 1 tab q12h
>12 years: Administer as in adults
May increase renal clearance of urate and lower serum uric acid levels
May interfere with urine laboratory tests for 5-hydroxyindoleacetic acid and urine testing for catecholamines
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
When prescribing medication that may suppress cough, important to identify cause of the cough and that suppression will not increase risk of clinical or physiologic complications
Corticosteroids: Topical decongestants
These agents are beneficial, especially if underlying rhinitis is present.
Beclomethasone (Beconase, Vancenase)
Has potent vasoconstrictive and anti-inflammatory activity. Has a weak hypothalamic-pituitary-adrenocortical (HPA) axis inhibitory potency when applied topically.
Adult
2 puffs in each nostril bid for 3 wk
Pediatric
Not established
None reported
Documented hypersensitivity; viral, fungal, and bacterial skin infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Prolonged use may increase systemic absorption of corticosteroids and may cause Cushing syndrome, reversible HPA axis suppression, hyperglycemia, and glycosuria; nasal septum perforation, angioedema, and bronchospasm may occur
Triamcinolone (Nasacort, Nasacort AQ)
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability.
Adult
2 puffs in each nostril qd
Pediatric
Not established
None reported
Documented hypersensitivity; fungal, viral, and bacterial skin infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Prolonged use can result in systemic absorption, which may cause Cushing syndrome, reversible HPA axis suppression, hyperglycemia, and glycosuria; nasal septum perforation, angioedema, or bronchospasm may occur
Flunisolide (AeroBid, Nasalide)
Inhibits bronchoconstriction mechanisms. Produces direct smooth muscle relaxation. May decrease number and activity of inflammatory cells, in turn decreasing airway hyperresponsiveness.
Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Does not depress the hypothalamus.
Adult
2 sprays/nostril bid/tid (25 mcg/spray)
Pediatric
<6 years: Not established
>6 years: 1 spray/nostril tid or 2 sprays/nostril bid (25 mcg/spray)
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Educate patient that this agent is not to be used as a rescue treatment for acute bronchospasm
More on Sinusitis, Acute |
| Overview: Sinusitis, Acute |
| Differential Diagnoses & Workup: Sinusitis, Acute |
 Treatment & Medication: Sinusitis, Acute |
| Follow-up: Sinusitis, Acute |
| References |
| « Previous Page | Next Page » |
References
Lanza DC, Kennedy DW. Adult rhinosinusitis defined. Otolaryngol Head Neck Surg. Sep 1997;117(3 Pt 2):S1-7. [Medline].
Gwaltney JM Jr. Acute community-acquired sinusitis. Clin Infect Dis. Dec 1996;23(6):1209-23; quiz 1224-5. [Medline].
Lucas JW, Schiller JS, Benson V. Summary health statistics for U.S. adults: National Health Interview Survey, 2001. Vital Health Stat 10. Jan 2004;(218):1-134. [Medline].
Ray NF, Baraniuk JN, Thamer M. Healthcare expenditures for sinusitis in 1996: contributions of asthma, rhinitis, and other airway disorders. J Allergy Clin Immunol. Mar 1999;103(3 Pt 1):408-14. [Medline].
Hansen JG, Schmidt H, Rosborg J, Lund E. Predicting acute maxillary sinusitis in a general practice population. BMJ. Jul 22 1995;311(6999):233-6. [Medline].
Gwaltney JM, Hendley JO, Simon G. Rhinovirus infections in an industrial population. II. Characteristics of illness and antibody response. JAMA. Nov 6 1967;202(6):494-500. [Medline].
Hickner JM, Bartlett JG, Besser RE. Principles of appropriate antibiotic use for acute rhinosinusitis in adults: background. Ann Intern Med. Mar 20 2001;134(6):498-505. [Medline].
Jacobs MR, Bajaksouzian S, Windau A, Good CE, Lin G, Pankuch GA. Susceptibility of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis to 17 oral antimicrobial agents based on pharmacodynamic parameters: 1998-2001 U S Surveillance Study. Clin Lab Med. Jun 2004;24(2):503-30. [Medline].
Payne SC, Benninger MS. Staphylococcus aureus is a major pathogen in acute bacterial rhinosinusitis: a meta-analysis. Clin Infect Dis. Nov 15 2007;45(10):e121-7. [Medline].
Brook I, Foote PA, Hausfeld JN. Increase in the frequency of recovery of meticillin-resistant Staphylococcus aureus in acute and chronic maxillary sinusitis. J Med Microbiol. Aug 2008;57:1015-7. [Medline].
[Best Evidence] Zalmanovici A, Yaphe J. Steroids for acute sinusitis. Cochrane Database Syst Rev. Apr 18 2007;CD005149. [Medline].
[Best Evidence] Williamson IG, Rumsby K, Benge S, Moore M, Smith PW, Cross M, et al. Antibiotics and topical nasal steroid for treatment of acute maxillary sinusitis: a randomized controlled trial. JAMA. Dec 5 2007;298(21):2487-96. [Medline].
[Best Evidence] Ahovuo-Saloranta A, Borisenko OV, Kovanen N, Varonen H, Rautakorpi UM, Williams JW Jr, et al. Antibiotics for acute maxillary sinusitis. Cochrane Database Syst Rev. Apr 16 2008;CD000243. [Medline].
Young J, De Sutter A, Merenstein D, van Essen GA, Kaiser L, Varonen H, et al. Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. Lancet. Mar 15 2008;371(9616):908-14. [Medline].
Cunha BA. Antibiotic Essentials. 7th ed. Boston, MA: Jones and Bartlett Publishers; 2008.
Bachert C, Meltzer EO. Effect of mometasone furoate nasal spray on quality of life of patients with acute rhinosinusitis. Rhinology. Sep 2007;45(3):190-6. [Medline].
Bailey BJ, Calhoun KH, et al. Head & Neck Surgery - Otolaryngology, 3rd edition. 2001;vol 1.
Benninger MS, Payne SC, Ferguson BJ, Hadley JA, Ahmad N. Endoscopically directed middle meatal cultures versus maxillary sinus taps in acute bacterial maxillary rhinosinusitis: a meta-analysis. Otolaryngol Head Neck Surg. Jan 2006;134(1):3-9. [Medline].
Berkow R, Beers MH, eds. Sinusitis. In: The Merck Manual of Diagnosis and Therapy. 16th ed. Whitehouse Station, NJ: Merck & Company; 1992. [Full Text].
Fagnan LJ. Acute sinusitis: A Cost-Effective Approach to Diagnosis and Treatment. In: American Family Physician. Leawood, Kans: American Academy of Family Physicians; 1998. [Full Text].
[Best Evidence] Karageorgopoulos DE, Giannopoulou KP, Grammatikos AP, Dimopoulos G, Falagas ME. Fluoroquinolones compared with beta-lactam antibiotics for the treatment of acute bacterial sinusitis: a meta-analysis of randomized controlled trials. CMAJ. Mar 25 2008;178(7):845-54. [Medline].
Meltzer EO, Bachert C, Staudinger H. Treating acute rhinosinusitis: comparing efficacy and safety of mometasone furoate nasal spray, amoxicillin, and placebo. J Allergy Clin Immunol. Dec 2005;116(6):1289-95. [Medline].
Meltzer EO, Hamilos DL, Hadley JA, Lanza DC, Marple BF, Nicklas RA, et al. Rhinosinusitis: developing guidance for clinical trials. J Allergy Clin Immunol. Nov 2006;118(5 Suppl):S17-61. [Medline].
National Ambulatory Medical Care Survey. Ambulatory Health Care Data. [Full Text].
Sinus and Allergy Health Partnership. Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Sinus and Allergy Health Partnership. Otolaryngol Head Neck Surg. Jul 2000;123(1 Pt 2):5-31. [Medline].
Skoner DP. Complications of allergic rhinitis. J Allergy Clin Immunol. June 2000;105:605-609. [Medline].
Varonen H, Rautakorpi UM, Nyberg S, Honkanen PO, Klaukka T, Palva E, et al. Implementing guidelines on acute maxillary sinusitis in general practice--a randomized controlled trial. Fam Pract. Apr 2007;24(2):201-6. [Medline].
Further Reading
Keywords
acute sinusitis, rhinosinusitis, acute rhinosinusitis, common cold, seasonal allergy, bacterial infection, flu, Streptococcus pneumoniae, S pneumoniae, Haemophilus influenzae, H influenzae, acute ethmomaxillary sinusitis, rhinitis, subacute sinusitis, subacute rhinosinusitis, maxillary sinusitis, ethmoidal sinusitis, frontal sinusitis, sphenoidal viral sinusitis, bacterial sinusitis, fungal orbital sinusitis, intracranial sinusitis, maxillary rhinosinusitis, ethmoidal rhinosinusitis, frontal rhinosinusitis, sphenoidal viral rhinosinusitis, bacterial rhinosinusitis, fungal orbital rhinosinusitis, intracranial rhinosinusitis, acute viral rhinosinusitis, acute bacterial rhinosinusitis, acute viral sinusitis, acute bacterial sinusitis
