This review examines the issues surrounding short-course
antibiotic therapy of acute
sinusitis. Acute bacterial
sinusitis is a common
community-acquired infection defined as
inflammation of one or more paranasal sinuses, most often the maxillary sinus. It is estimated that 0.5-5% of colds are complicated by acute
sinusitis. Up to 1 in 20
upper respiratory tract infections is complicated by bacterial
sinusitis, most often caused by Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus. Early diagnosis and appropriate
antibiotic therapy, in combination with agents that relieve nasal congestion, are important factors in preventing suppurative complications. Left untreated, it could lead to the development of chronic
sinusitis or epidural or
subdural empyema,
brain abscess, or cavernosus
sinus thrombosis. Isolation of the causal organism is often lacking in the community setting. Empiric
antibiotic therapy should provide adequate coverage against the most important pathogens. Guidelines from different specialist societies based on current scientific knowledge are helpful in making the decision on which
drug to use. Recommendations for
duration of treatment of acute
sinusitis are inconsistent between different guidelines but usually
a 10- to 14-day treatment course is recommended.Recognition that the 10- to 14-day
duration of therapy is not derived from a strong scientific or medical rationale has led some clinicians to call for shortening the duration of
antibiotic therapy for patients with
upper respiratory tract infections. Accumulating evidence suggests that short-course (< or =5 days)
antibiotic therapy may have equivalent or superior efficacy compared with traditional longer (10-14 days)
therapies and offers a number of advantages. Results of a number of clinical trials investigating 5-day
therapy with oral
cephalosporins, new
quinolones or
ketolides in acute (presumed) bacterial
sinusitis in comparison with traditional 10-day treatment courses have been published demonstrating equivalent efficacy of 5-day and 10-day regimens. The evidence reviewed in this article strongly supports reduction of the traditional 10-day course of antibacterial
therapy to a 5-day course for uncomplicated acute
maxillary sinusitis in adults. Further research related to the duration of antibacterial
therapy for
sinusitis is needed in children and in adult patients with frontal, ethmoidal and
sphenoidal sinusitis.