Sinusitis, Acute, Medical Treatment Differential Diagnoses

  • Author: Steven E Sobol, MD, FRCSC, MSc, FAAP; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Nov 19, 2009
 
 

Differential Diagnoses

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Contributor Information and Disclosures
Author

Steven E Sobol, MD, FRCSC, MSc, FAAP  Assistant Professor, Director of Pediatric Otolaryngology, Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine; Otolaryngologist-In-Chief, Children's Healthcare of Atlanta at Egleston

Steven E Sobol, MD, FRCSC, MSc, FAAP is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Melvin D Schloss, MD, FRCSC  Director of Pediatric Otolaryngology, Professor, Department of Otolaryngology, McGill University, Canada

Melvin D Schloss, MD, FRCSC is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Ted L Tewfik, MD, FRCS(C)  Professor, Department of Otolaryngology, Director of Continuing Medical Education of Otolaryngology, McGill University Medical School; Director, Director of Professional Affairs of Otolaryngology, Department of Otolaryngology, Montreal Children's Hospital; Senior Staff, Montreal General Hospital and Royal Victoria Hospital

Ted L Tewfik, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Society of Pediatric Otolaryngology, Canadian Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Jack A Coleman, MD  Consulting Staff, Franklin Surgical Associates

Jack A Coleman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Sleep Medicine, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society for Laser Medicine and Surgery, and Association of Military Surgeons of the US

Disclosure: accarent, inc Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Stephen G Batuello, MD  Consulting Staff, Colorado ENT Specialists

Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position

References

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  2. Ray NF, Baraniuk JN, Thamer M, Rinehart CS, Gergen PJ, Kaliner 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].

  3. [Guideline] Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. Sep 2007;137(3 Suppl):S1-31. [Medline].

  4. Savolainen S, Jousimies-Somer H, Karjalainen J. Do simple laboratory tests help in etiologic diagnosis in acute maxillary sinusitis?. Acta Otolaryngol Suppl. 1997;529:144-7. [Medline].

  5. Slack CL, Dahn KA, Abzug MJ, Chan KH. Antibiotic-resistant bacteria in pediatric chronic sinusitis. Pediatr Infect Dis J. Mar 2001;20(3):247-50. [Medline].

  6. Sobol SE, Marchand J, Tewfik TL, Manoukian JJ, Schloss MD. Orbital complications of sinusitis in children. J Otolaryngol. Jun 2002;31(3):131-6. [Medline].

  7. Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope. Sep 1970;80(9):1414-28. [Medline].

  8. [Guideline] Slavin RG, Spector SL, Bernstein IL, Kaliner MA, Kennedy DW, Virant FS, et al. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol. Dec 2005;116(6 Suppl):S13-47. [Medline].

  9. AHCPR Evidence Report. Agency for Health Care Policy and Research. In: Diagnosis and treatment of acute bacterial rhinosinusitis. Rockville, MD. 1999.

  10. Brook I, Gooch WM III, Jenkins SG. Medical Management of acute bacterial sinusitis. Recommendations of a clinical advisory committee on pediatric and adult sinusitis. Ann Otol Rhinol Laryngol. 2000;109(Suppl):2-20.

  11. Conrad DA, Jenson HB. Management of acute bacterial rhinosinusitis. Curr Opin Pediatr. 2002;14(1):86-90.

  12. Eibling DE. Maxillary Sinus: Irrigation Techniques. In: Myers EN, ed. Operative Otolaryngology-Head and Neck Surgery. Philadelphia, Pa: WB Saunders; 1997:81-85.

  13. Frenkiel S. Embryology of the Nose and Sinuses. In: Tewfik TL, Der Kaloustian VM, eds. Congenital Anomalies of the Ear, Nose, and Throat. New York: Oxford University Press; 1997:183-187.

  14. Graney DO, Rice DH. Anatomy. In: Cummings CW, Frederickson JM, Harker LA, Krause CJ, Richardson MA, Schuller DE, eds. Otolaryngology-Head & Neck Surgery. 3rd ed. St. Louis: Mosby; 1998:1059-1064.

  15. International Rhinosinusitis Advisory Board. Infectious rhinosinusitis in adults: classification, etiology and management. International Rhinosinusitis Advisory Board. Ear Nose Throat J. Dec 1997;76(12 Suppl):1-22. [Medline].

  16. Johnson JT, Ferguson BJ. Infection. In: Cummings CW, Frederickson JM, Harker LA, Krause CJ, Richardson MA, Schuller DE, eds. Otolaryngology-Head & Neck Surgery. 3rd ed. St. Louis: Mosby; 1998:1107-1118.

  17. Josephson GD, Gross CW. Diagnosis & management of acute & chronic sinusitis. Compr Ther. Nov 1997;23(11):708-14. [Medline].

  18. Kaliner MA, Osguthorpe JD, Fireman P. Sinusitis: bench to bedside. Current findings, future directions. Otolaryngol Head Neck Surg. Jun 1997;116(6 Pt 2):S1-20. [Medline].

  19. Laine K, Maatta T, Varonen H. Diagnosing acute maxillary sinusitis in primary care: a comparison of ultrasound, clinical examination and radiography. Rhinology. Mar 1998;36(1):2-6. [Medline].

  20. Low DE, Desrosiers M, McSherry J. A practical guide for the diagnosis and treatment of acute sinusitis. CMAJ. Mar 15 1997;156 Suppl 6:S1-14. [Medline].

  21. Manning SC. Medical Management of Infectious and Inflammatory Disease. In: Cummings CW, Frederickson JM, Harker LA, Krause CJ, Richardson MA, Schuller DE, eds. Otolaryngology-Head & Neck Surgery. 3rd ed. St. Louis: Mosby; 1998:1135-1144.

  22. McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA. Jan 18 1995;273(3):214-9. [Medline].

  23. Poole MD. A focus on acute sinusitis in adults: changes in disease management. Am J Med. May 3 1999;106(5A):38S-47S; discussion 48S-52S. [Medline].

  24. Rhys-Evans PH. Anatomy of the Nose and Paranasal Sinuses. In: Kerr AG, Groves J, eds. Scott-Brown's Otolaryngology. 5th ed. London: Butterworths; 1987:138-161.

  25. Talmor M, Li P, Barie PS. Acute paranasal sinusitis in critically ill patients: guidelines for prevention, diagnosis, and treatment. Clin Infect Dis. Dec 1997;25(6):1441-6. [Medline].

  26. Taylor JA, Weber W, Standish L, et al. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA. Dec 3 2003;290(21):2824-30. [Medline].

  27. Wald ER. Expanded role of group A streptococci in children with upper respiratory infections. Pediatr Infect Dis J. Aug 1999;18(8):663-5. [Medline].

  28. Wald ER. Microbiology of acute and chronic sinusitis in children and adults. Am J Med Sci. Jul 1998;316(1):13-20. [Medline].

  29. Wald ER. Sinusitis. Pediatr Ann. Dec 1998;27(12):811-8. [Medline].

  30. Westergren V. Artificial ventilation-acquired sinopathy in the critically ill - the maxillary sinuses revisited. Clin Exp Allergy. Mar 1999;29(3):298-305. [Medline].

 
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Air-fluid level (arrow) in the maxillary sinus suggests sinusitis.
Table 1. Dosage, Route, and Spectrum of Activity of Commonly Used First-Line Antibiotics*
Antibiotic Dosage Streptococcus pneumoniaeHaemophilus influenzaeMoraxella catarrhalisAnaerobic bacteria
SensitiveIntermediateResistant
Amoxicillin500 mg PO tid++++++++++
Clarithromycin250-500 mg PO bid+++++++++++
Azithromycin500 mg PO first day, then



250 mg/d PO for 4 days



+++++++++++
Table 2. Dosage, Route, and Spectrum of Activity of Commonly Used Second-Line Antibiotics*
Antibiotic Dosage Streptococcus pneumoniaeHaemophilus influenzaeMoraxella catarrhalisAnaerobic bacteria
SensitiveIntermediateResistant
Amoxicillin/clavulanate500 mg PO tid+++++++++++++++
Cefuroxime250-500 mg PO bid+++++++++++++
Cefpodoxime



+



cefixime



200 mg PO bid



400 mg/d PO



-



++



+++



-



++



-



+



+++



+++



+++



+++



-



Ciprofloxacin500-750 mg PO bid++++++++++
Levofloxacin500 mg/d PO++++++++++++++++++
Trovafloxacin200 mg/d PO++++++++++++++++++
Clindamycin300 mg PO tid+++++++++--+++
Metronidazole500 mg PO tid-----+++
Table 3. Dosage, Route, and Spectrum of Activity of Commonly Used Intravenous Antibiotics*
Antibiotic Dosage Streptococcus pneumoniaeHaemophilus influenzaeMoraxella catarrhalisGram-negative Anaerobic bacteria
Piperacillin3-4 g IV q4-6h++++-++++++
Piperacillin/tazobactam3.375 g IV q6h++++++++++++++
Ticarcillin3 g IV q4h+++--+++++
Ticarcillin/clavulanate3.1 g IV q4h++++++-+++++
Imipenem500 mg IV q6h+++++++++++++++
Meropenem1 g IV q8h++++++++++++++
Cefuroxime1 g IV q8h+++++++++++++
Ceftriaxone2 g IV bid++++++++++++++
Cefotaxime2 g IV q4-6h++++++++++++++
Ceftazidime2 g IV q8h++++++++++++++
Gentamicin1.7 mg/kg IV q8h-++++++++-
Tobramycin1.7 mg/kg IV q8h-++++++++-
Vancomycin1 g IV q6-12h+++---++
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