Giftedness: Understanding Everyday Neurobiology for Self-Knowledge
The diagnosis and treatment of acute bacterial sinusitis
1. The Diagnosis and Treatment of Acute Bacterial Sinusitis
At a recent symposium, Dr. Sabena Toor Hendrix of Cedars-Sinai Medical Center gave a
presentation on the Clinical Overview of Acute Bacterial Sinusitis (ABS) and Community
Acquired Pneumonia CAP). In the presentation, Dr. Hendrix discussed how better diagnosis and
treatment of acute bacterial sinusitis would benefit the patients in the long run.
About Acute Bacterial Sinusitis
As a physician you see a variety of patients each and every year. Determining whether an
infection is viral or bacterial will determine the proper treatment to be prescribed. When it comes
to viral infections they:
Are self-limiting;
Start off as a viral infection 90% of the time;
Can affect patients at a minimum of 2-3 times a year and this result in them seeking
medical treatment;
Are inciting causes for the development of sinusitis or pneumonia;
Generally will result into formal acute bacterial infection (ABS).
About 20 million patients a year are diagnosed with ABS within the United States. It has been
determined that ABS is the 5th most common reason why antibiotics are prescribed today.
However, it needs to be ruled out that a patient is not presenting themselves with pharyngitis,
pneumonia or otitis media.
Diagnosing Acute Bacterial Sinusitis
Diagnosing ABS is important to prescribing the proper course of treatment. We need to discern if
the patient is suffering from autoimmune disease, an infectious disease or an allergic component.
Once it has been specified that the patient’s is suffering from an infectious disease we need to be
specific in noting if this infection is a viral UTI, an acute bacterial infection or a chronic
infection. It is wise to note that some patients may start out as a viral infection but end up with an
acute bacterial infection. A patient may also go from an acute phase into a chronic phase. As a
physician, discerning between these three stages is vital to diagnosis and treatment.
The three most common reasons for bacterial sinusitis and URTI include:
Strep/Pneumonia
Haemophilus Influenza
Moraxella Catarrhalis
2. This is why proper diagnosis is critical to the treatment process. When it comes to the sinuses the
maxillary and ethmoidal sinuses seem to cause the most problems in patients. Patients suffering
from sinuses issues may present with:
Nasal Drainage
Sinus Congestion Lasting 3 to 5 Days
Extreme Frontal Pressure
Nasal Drip
Earache
We should note that the symptoms may or may not be accompanied by fever, cough and fatigue.
The fullness and pressure patients are feeling is due to the maxillary and ethmoidal sinuses being
filled.
Discerning Between Viral URI and Bacterial
Knowing whether a patient is suffering from viral URI or bacterial is important to prescribing the
proper treatment. If a patient has not improved within 5 to 7 days then it needs to be considered
that the patients viral infection may have turned into ABS. Diagnostic modalities will vary
according to the processes and procedures in place at your facility but can include a physical
examination of the ears, nose and throat, MRI imaging, CT scans, fiberoptic endoscopy, anterior
rhinoscopy and transilluminion.
Patients who may have compromised immunity systems need to be monitored closely. This can
include patients with cancer, immune disorders, HIV, lupus or renal disease.
Treating Acute Bacterial Sinusitis
Studies have shown that over time, patients can build up a resistance to antibiotics. That is why
you want to diagnose properly, treat with the appropriate medication and dosage and only
prescribe the treatment for a period of time to adequately get rid of the infection and get the
patient back to baseline and functioning. Remember that we want the best course of treatment for
the patient and should always consider the medications safety profile, side effects and if it is
going to work quickly.
Today’s patients are more educated and smarter when it comes to their health. However at the
end of the day prescribing the proper course of treatment for them is the most important factor.
In addition we need to educate our patients on their prescribed treatments. Too often patients will
stop taking a prescribed medication once they begin to feel better. This can cause the infection to
flare up again. Patients will also save unused medications for a later date when “they” feel that
they are experiencing the same symptoms and will self-medicate. This can not only be in
effective but cause the patient to build up a resistance to the antibiotic and this rendering it
3. ineffective for future use. So it is vital that the patient understand the reasons for taking the
prescribed treatment for the recommended amount of time.
Following these guidelines will allow us to reduce prescribing of antibiotics in viral illnesses and
increase the use of appropriate antimicrobial therapy when bacterial disease is likely.