Bacteriology and antibiotics treatment of maxillary sinusitis: a prospective study
Keywords:Water’s view, DNE, Antral lavage, Efficacy, Amoxicillin-Clavulinate
Background: Sinusitis is one of the commonest causes of patients visit to the otorhinolaryngologist, around one in five cases. The prevalence of sinusitis (146/1000) has been reported. Estimates suggest that clinical condition of sinusitis is more widespread than arthritis and/or hypertension. Sinusitis significantly impacts quality of life, even in comparison to chronic debilitating diseases such as diabetes and congestive heart failure. Sinusitis is the fifth most common medical diagnosis for which antibiotics are prescribed. Sinusitis is usually managed with a 10 days complete course of appropriate sensitive antibiotics. To achieve this goal, there should be some diagnostic modalities which guide towards exact diagnosis as well as safe intervention and cost effective. Over past decade, x-ray paranasal sinuses (Water’s view) and nasal endoscopy have been used successfully as diagnostic modalities in sinus disease.
Methods: 100 patients presenting with complaints of sinusitis to the ENT OPD KIMSDU Karad, Maharashtra India were selected randomly (more than 12 yrs of age). All of them were examined clinically and subjected to X -ray PNS (Water’s view) and diagnostic nasal endoscopy [DNE]. Antral lavage was done for all the patients and returning fluid sent for culture and sensitivity. Results were evaluated by statistical analysis using chi square test and evaluating p value tabulated and compared. Appropriate antibiotics were advised orally for 10 days, on the basis of culture reports, such as Amoxcillin-Clavulinate 625 mg BD, Cefpodoxime proxetil 200 mg BD, Levofloxacin 500 mg OD, Ciprofloxacin-Tinidazole (500:600 mg) BD.
Results: Majority of the patients were in the age group of 20-29 years (46%) and females (53%). Most common organisms causing maxillary sinusitis was- S.aureus (coagulase+29%). It was found that Amoxicillin-Clavulinate has highest efficacy as compared to other antibiotics.
Conclusions: According to our study, most common organisms causing acute maxillary sinusitis in this study are S aureus (coagulase+), S pnemoniae and Enterobacteriacae. Most common organisms isolated are anaerobic Peptostreptococcus, coagulase positive S. aureus and fusobacterium in chronic rhinosinusitis. Efficacy of Amoxicillin-Clavulinic acid was 96% clinically, 94% based on results on DNE findings and 87% by radiological success rate which is statistical more significant than other class of antibiotics. So amoxicillin clavulinic acid can be considered as first line of drug for treating bacterial rhinosinusitis.
Agency for Health Care Policy and Research. Diagnosis and treatment of acute bacterial rhinosinusitis. Evid Rep Technol Assess (Summ). 1999;9:1-5.
Scheid DC, Hamm RM. Acute bacterial rhinosinusitis in adults: part I. Evaluation. J Am Fam Phys. 2004;70:1685-92.
Ah-See KW. Sinusitis (acute). Clinical Evidence. Available at: www.clinicalevidence.org/ceweb/ conditions/ent/0511/0511_contribdetails.jspwww.clinicalevidence.org/ceweb/conditions/ent/0511/0511_contribdetails.jsp. Accessed on 3 March 2017.
Williams Jr JW, Aguilar C, Cornell J, Chiquette E. Dolor RJ, Makela M, et al. Antibiotics for acute maxillary sinusitis. Cochrane Database Syst Rev. 2003;(2):CD000243.
Fokkens W, Lund V, Bachert C, Clement P, Helllings P, Holmstrom M, et al. EAACI position paper on rhinosinusitis and nasal polyps executive summary. Allergy. 2005;60:583-601.
Revonta M, Sounpaa J. Diagnosis of subacute maxillary sinusitis in children. J Laryngol Otol. 1981;95:133-40.
Axelsson AA, Grebelius N, Chidekel N, Jensen C. The correlation between the radiological examination and the irrigation findings in maxillary sinusitis. Acta Otolaryngol. 1970;69:302-6.
McNeil RA (Belfast). Comparison of findings on transillumination, X-ray and lavage of maxillary sinus. J Laryngol Otol. 1963;77:1009-13.
Raymond T Hinde. A review of the diagnostic problem in one hundred cases of chronic maxillary sinusitis. J Laryngol Otol, Nov 1950;64:687-92.
Vourinen P, Kauppila A, Pulkkinerr K. Comparison of results of roentgen examination and antral puncture and irrigation. J Laryngol Otol. 1962;76:359-64.
Arruda LK, Mimica IM, Solé D, Weckx LL, Schoettler J, Heiner DC, et al. Abnormal Maxi llary sinus radiographs in children. Do they represent bacterial infect ion? Paediatrics. 1990;85(4):553-8.
Evans FO, Sydnor JB, Moore WEC, Moore GR, Manwaring JL, Brill AH, et al. Sinusitis of maxillary antrum. New England J Med. 1975;293:735-9.
Sen MK, Samaddar RR. A correlation between the findings of X-ray PNS and antral washout. Indian J Otolaryngol Head Neck Surg. 1993;45(2):70-2.
Ezeanolue BC, Aneke EC, Nwagbo DF. Correlation of plain radiological diagnostic features with antral la vage results in chronic maxillary sinusitis. West African J Med. 2000;19(1):16-8.
Kurien M, Raman R, Job A. Roentgen Examination of Maxillary Sinus, Antral Puncture and Irrigation – A Comparative study. Sing Med J. 1989;30:565-7.
Elwamy S, Abdell-Kreim A, Tulaii M. Relevance of Conventional Waters view in evaluating chronic bacterial maxillary sinusitis. J Laryngol Otol. 1985;99:1233-44.
Patel AK, Patel A, Sing B, Sharma MK. The study of functional endoscopic sinus surgery in patients of sinus headache. Int J Biology Medical Res. 2012;3(3):1924-30.
Shahizon AM, Suraya A, Rozmnan Z, Aini AA, Gendeh BS. Correlation of Computed Tomography and Nasal Endoscopic Findings in Chronic Rhinosinusitis. Med J Malaysia. 2008;63(3):211-5.
Brook I. Microbiology and antimicrobial management of sinusitis. Otolaryngol Clin North Am. 2004;37:253–66.
AHRQ Publication No. 05-E020-2005.