Antimicrobial therapy for sinusitis.

Rational antibiotic therapy for sinusitis is a difficult goal, made difficult by few satisfactory comparative trials with sufficient clinical power, the large numbers of therapeutic options, prescribing pressures from the pharmaceutical industry, and rapid changes in bacterial resistance patterns. Controversies exist about the relative need of antibiotics for uncomplicated disease, duration of therapy, and relative efficacy of various agents. Nonetheless, limited data support the notion of superior efficacy of more potent antimicrobials, and an analysis of in vitro activity versus tissue concentrations of the various antibiotics can predict efficacy of eradication of causative bacteria. Multidrug-resistant pneumococci render any algorithm for empiric antibiotic use problematic and prone to fail.