Concomitant acute sinusitis and acute lung rejection

Two lung transplant recipients had concomitant acute sinusitis and acute lung rejection. Antibiotics and decongestants alleviated the sinusitis, but the symptoms of cough and dyspnea as well as spirometric defects necessitated treatment of acute lung rejection. In patients with clinical evidence of acute sinusitis after lung transplantation, concomitant acute lung rejection should be suspected if dyspnea or pulmonary dysfunction is also present. This appears to be the first report of concomitant acute sinusitis and acute lung rejection.     

Update on treatment guidelines for acute bacterial sinusitis

Acute bacterial sinusitis (ABS) is a common complication of viral upper respiratory tract infections and represents a considerable social burden both in terms of diminished quality of life for the patient and the economic implications of decreased productivity and treatment costs. Several national health authorities have developed guidelines for the management of ABS, which aim to promote rational selection of anti-bacterial therapy to optimise clinical outcomes while minimising the potential for selection of anti-bacterial resistance as a result of inappropriate anti-bacterial usage. This article provides an overview of current guidelines, with particular focus on the clinical significance of variations in treatment recommendations and new treatment options, such as the ketolide telithromycin, which was recently added to a number of national treatment guidelines.     

Complications of acute frontal sinusitis.

The bone separating the frontal sinus from the anterior cranial fossa and the orbit is often quite thin. This, plus the interrelated venous drainage system of these areas, forms the anatomic basis for serious orbital and intracranial complications that must be recognized early. These include orbital cellulitis and abscess, cavernous sinus thrombosis, subdural and brain abscess and meningitis. Early hospitalization for intravenous antibiotic therapy and, occasionally, emergency surgical drainage are required.     

Prescribing for children

Many children receive urgent care within emergency departments. Children are at increased risk from the use of medicines for a number of reasons, including the need to calculate a weight or age-based dose or administration of a fraction or proportion of an adult formulation of medicine. Aspects of good practice from the English National Service Framework (NSF) for Children, Young People and Maternity Services are highlighted. The importance of good medicines reconciliation is discussed. Websites that support emergency care practitioners to address medicines adherence and counselling of parents and children on use of medicines are presented. The drug related needs of children and young people must be assessed on an individual basis. Guidelines are outlined to support safe prescribing and medicines administration.     

Comparison of cyclacillin and amoxicillin for therapy for acute maxillary sinusitis.

Cyclacillin, a new aminosalicylic semisynthetic penicillin, was compared with amoxicillin for the therapy of acute bacterial maxillary sinusitis in 80 patients (ages, 12 to 70 years) in a prospective, double-blind, randomized clinical trial. Direct sinus aspirations for quantitative culture were done for all patients before and after 10 days of therapy. Both drugs were administered at a dosage of 500 mg orally three times daily. Among culture-positive patients, clinical cure was achieved in 23 of 26 patients and 25 of 27 patients treated with cyclacillin and amoxicillin, respectively, for an overall cure rate of 91%. Bacteriologic failure occurred in 9% (4 of 44 patients); 3 of the 4 failures were in the cyclacillin group. There was no correlation between clinical or bacteriologic cure and the results of sinus transillumination (clear, dark) at follow-up. Initial direct sinus aspirates were positive in 57 of 80 cases (70%): 25 (44%) of these were the result of Streptococcus pneumoniae and 23 (40%) were the result of Haemophilus influenzae. All of these isolates were susceptible (MIC, less than or equal to 0.5 microgram/ml) to both study drugs; no ampicillin-resistant H. influenzae was recovered. On day 10 of therapy, mean concentrations of both drugs in serum were 2.5 to 2.7 micrograms/ml, but no antibiotic was detectable in 20 of 21 simultaneous sinus aspirates. Adverse effects (rash, diarrhea) were infrequent and similar in both groups. Cyclacillin appears equivalent to amoxicillin in the therapy of acute maxillary sinusitis.     

Moxifloxacin in the treatment of acute maxillary sinusitis after first-line treatment failure and acute sinusitis with high risk of complications

This multicentre, prospective study evaluated the efficacy and safety of 7-day oral moxifloxacin (400 mg/day) for treatment of acute maxillary sinusitis after first-line treatment failure (group 1), and acute sinusitis with high risk of complications (group 2). Two hundred and fifty-eight patients with radiologically confirmed acute sinusitis were enrolled by 52 investigators; 216 patients (83.7%) qualified for per protocol efficacy analysis (group 1, n = 175; group 2, n = 41), and 92 for bacteriological analysis. Samples were collected from the middle meatus. The clinical success rate 7-10 days post-treatment was 92.6%. Bacteriological success rates were 95.7% after 3-4 days of treatment, and 97.2% and 95.2%, in group 1 and group 2, respectively, at 7-10 days post-treatment. Drug-related adverse events, including abdominal pain (2.4%), nausea (2.4%) and diarrhoea (1.2%), were reported in 12.2% of patients. Overall, moxifloxacin therapy resulted in rapid bacteriological eradication, with a high rate of clinical success.     

The diagnosis and management of acute and chronic sinusitis

Both acute and chronic sinusitis are common diseases associated with significant morbidity and consumption of health care dollars. Acute sinusitis is caused by an infectious process and can often be difficult to distinguish from a viral upper respiratory infection, as signs, symptoms, and even the results of most diagnostic tests overlap. In contrast, chronic sinusitis is an inflammatory disease and, contrary to common practice, long term antibiotics are likely not useful. This article reviews the diagnosis and management of both acute and chronic sinusitis and includes discussion of the prevalence of disease, our current understanding of disease pathogenesis, diagnosis, and contemporary treatment.     

Prescribing

All doctors need to consider what medical and social factors influence prescribing, and to what extent their personal habits and those of their peers are rational and responsible. Exam candidates are given some background pointers.     

Predictors of duration of acute sinusitis episodes treated with antibiotics

Objective - To evaluate which factors present at the onset of acute sinusitis predict the duration of illness among adult patients treated with antibiotics. Design - Cohort study with a 30-day follow-up. Setting - Norwegian general practice. Subjects - Eighty-six adult patients with a clinical diagnosis of acute sinusitis confirmed by Computed Tomography. Methods - Signs, symptoms and other variables present at the onset of treatment were dichotomized and analysed bivariately with duration of the sinusitis episode, using the log-rank test. Age, gender, and factors with p-values under 0.15 were modelled in a Cox regression analysis to assess independent predictors for illness duration. Main outcome measure - Duration of illness. Results - Illness duration was significantly and positively associated with increasing age and with a higher clinical severity score at the onset of treatment. No other factors were independent predictors of illness duration. Conclusion - The age of the patient and the clinical severity of the sinusitis at the onset of treatment were independent predictors of illness duration in adult patients treated with antibiotics.     

Brodimoprim versus amoxicillin in the treatment of acute sinusitis.

A new dihydrofolate inhibitor, brodimoprim, was compared with amoxicillin in the treatment of acute sinusitis in a general practice controlled study. Eighty adult outpatients with acute sinusitis were randomly assigned to receive 200 mg of brodimoprim once daily or 750 mg of amoxicillin thrice daily for seven to 10 days. The mean duration of treatment was 9.2 days in the brodimoprim group and 9.1 days in the amoxicillin group. In most patients the symptoms of sinusitis had disappeared by day 5 of treatment. The reduction in symptom scores was more marked in the brodimoprim-treated patients than in the amoxicillin-treated patients. Bacteriologic examinations after treatment were performed in 20 patients of each treatment group. At completion of treatment, the causative pathogen had been eradicated in 14 of 20 patients treated with brodimoprim and in 12 of 20 patients treated with amoxicillin. Treatment side effects were reported by two brodimoprim-treated patients (skin reactions) and by six amoxicillin-treated patients (gastrointestinal distrubances or skin reactions). The results indicate that brodimoprim is safe and effective in the treatment of acute sinusitis in adults.