Medical Management

Much is unknown about antibiotic therapy and chronic sinusitis. Prospective studies are lacking in the use of antihistamines and decongestants. Theoretically, decongestants would decrease the amount of edema and open the ostia. This has not been proved, however. Topical steroids have been shown to decrease edema within 2 weeks and may be of modest benefit. If reflux is present, it should be aggressively treated before surgical intervention is attempted.

Increasing resistance of S. pneumoniae is of increasing concern. It is the most common organism to cause acute sinusitis, but it has become dramatically more resistant. The current recommendations for treatment of cultured resistant bacteria are high-dose amoxicillin (80 to 90 mg/kg/day), azithromycin, clindamycin, and rifampin.35 In patients with resistant bacteria, surgery may be necessary to improve drainage.

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