Acute bacterial sinusitis

Background

• See also nosocomial sinusitis and invasive fungal sinusitis

Microbiology

• Streptococcus pneumoniae (most common; 41% in adults and children)
• Non-typable Haemophilus influenzae (35% in adults, 27% in children)
• Moraxella catarrhalis (4% in adults, 22% in children)
• Streptococci (7% in adults and children)
• Anaerobes (7% in adults)
• Staphylococcus aureus (3% in adults)

Risk Factors

• Systemic factors
  • Viral upper respiratory infection
  • Allergic rhinitis and asthma
  • Cystic fibrosis
  • Immune disorders including agammaglobulinemia, HIV, and chronic granulomatous disease
  • Ciliary dyskinesia
  • Tobacco smoke
• Mechanical factors: choanal atresia, cleft palate, deviated septum, nasal polyps, foreign body, tumour, ethmoid bullae
• Local factors: facial trauma, swimming and diving, rhinitis medicamentosa, nasal intubation

Clinical Manifestations

• May have periorbital edema with involvement of the ethmoid sinuses that must be differentiated from periorbital cellulitis

Complications

• Complications occur more commonly in sinusitis including the frontal and ethmoidsinuses
• Intracranial: subdural empyema, epidural abscess, intraparenchymal brain abscess, meningitis, and venous sinus thrombosis
  • Consider these diagnoses with fever, altered mentation, seizures, or focal neurologic deficits
• Extracranial: orbital cellulitis, orbital abscess, and subperiosteal abscess, including Pott puffy tumour

Management

• For adults, treat with amoxicillin-clavulanic acid for 10 days
• For children
  • Treat if severe, and can either treat or watch and wait if mild to moderate
  • Use amoxicillin with or without clavulanic acid
• Alternatives include cefpodoxime, cefixime, cefdinir, azithromycin, clarithromycin, levofloxacin, and moxifloxacin
• Large-volume nasal irrigation may be helpful, especially with chronic symptoms