DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20174318

Bacteriology and antibiotics treatment of maxillary sinusitis: a prospective study

Santosh Malashetti, Abhay Havle, Rajesh Karembelkar

Abstract


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. 


Keywords


Water’s view, DNE, Antral lavage, Efficacy, Amoxicillin-Clavulinate

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