Acute infection of the paranasal sinuses causes significant morbidity. Since oedema of the mucous membrane hinders the drainage of pus, a logical first step is to open the obstructed passage with a sympathomimetic vasoconstrictor, e.g. ephedrine nasal drops. Antibiotic therapy produces limited additional clinical benefit, but the common infecting organism—Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, Moraxella (Branha-mella) catarrhalis-—usually respond to oral amoxicillin (with or without clavulanic acid) or doxycycline, if the case is serious enough to warrant antibiotic therapy.
In chronic sinusitis, correction of the anatomical abnormalities (polypi, nasal septum deviation) is often important. Very diverse organisms, many of them normal inhabitants of the upper respiratory tract, may be cultured, e.g. anaerobic streptococci, Bacteroides spp., and a judgement is required as to whether any particular organism is acting as a pathogen. Choice of antibiotic should be guided by culture and sensitivity testing; therapy may need to be prolonged.
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