ACUTE SINUSITIS - PRINCIPLES OF JUDICIOUS USE OF ANTIMICROBIAL AGENTS

Establishing an accurate diagnosis of bacterial sinusitis is challengi ng but critical, because viral rhinosinusitis is at least 20 to 200 ti mes more common than bacterial infection of the sinuses. Strict criter ia for clinical diagnosis that require either prolonged and persistent symptoms or an acute severe presentation are supported with published evidence. Radiographic imaging of the sinuses should be used only in very selected circumstances. A majority of patients with the common co ld will meet radiographic criteria for sinusitis early in the course o f their illness. For patients meeting these strict criteria, an approp riate narrow-spectrum antimicrobial agent will be of modest benefit co mpared with symptomatic treatment alone.