Issues in the management of bacterial sinusitis.

Office visits for acute bacterial rhinosinusitis (ABRS) have increased steadily in the past 2 decades, and ABRS accounted for 0.4% of ambulatory diagnoses in 1995, ranking as the fifth most common diagnosis for which an antibiotic is prescribed. ABRS typically begins as a viral respiratory tract infection, but bacterial growth is demonstrated in 60% of adults with upper respiratory tract infection symptoms of at least 10 days duration. Important factors to consider when selecting an antibiotic regimen for ABRS include: severity of disease, rate of disease progression, earlier antibiotic treatment, regional resistance rates, and, in children, an age <5 years and attendance in day care centers. The most prevalent causative pathogens of sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Antimicrobial agent use is under significant scrutiny in this era of emerging bacterial resistance, and antibiotic treatment for sinusitis should include consideration of drug pharmacodynamics. Several agents, once considered first-line therapies, can no longer be considered dependable in this role. Rather, newer antibiotics may be called on to provide efficacy and forestall additional antimicrobial resistance among respiratory tract pathogens.