Enfoque diagnóstico y terapéutico de los pacientes adultos con sospecha de sinusitis aguda
Revista chilena de infectología
Diagnosis and treatment of adult patients with acute sinusitis suspicion Acute bacterial sinusitis (ABS) is a common cause of morbidity and office consultation in adult patients and should be distinguished from a viral cause. Most patients will recover spontaneously even without antibiotic treatment, although antimicrobials reduce ABS symptoms and their severity. Different strategies can be used to diagnose ABS, being bacterial culture after sinus puncture the gold standard method, although
... ethod, although this invasive alternative can not be routinely recommended. Case detection by a specific constellation of sign and symptoms offer a reasonable sensitivity and specificity (~76% each), quite similar to the performance of conventional radiological studies but at a lesser cost. Ultrasound and tomographic studies do not improve specificity and are less available or more expensive to perform. Amoxicillin continues to be the preferred antimicrobial due to its efficacy, tolerance and low cost. Other compounds such as macrolides, cefalosporins, respiratory quinolones and ketolides do not enhance efficacy or safety and are associated with higher acquisition costs. Penicillin resistant pneumococcal isolates do no affect therapy of extrameningeal infections such as ABS due to the moderate increment of the minimal inhibitory concentration for penicillin. Resistance to cotrimoxazole among pneumococcal isolates precludes its use in Chile.