[Acute rhinosinusitis and sinusitis].

Abstract

During the common cold in the adult, involvement of the sinusal mucosa, confirmed by CT scan, is virtually constant and justifies the term "rhinosinusitis" that is now applied. The presence of bacterial superinfection can only be demonstrated by positive laboratory results on a sample, which is never performed in usual practice; thus the practitioner must rely on presumptive factors. Among them, an essential element is the unilateral nature of painful symptoms and purulent rhinorrhoea. When symptoms are bilateral, antibiotics should not be prescribed except when the condition has not been resolved by symptomatic treatment during several days. In such cases, other important discriminating factors are also examination showing pus originating from below the middle meatus or sinusal X-ray showing a liquid level or a total opacity. On the other hand, clinical suspicion of localisation of infection in the frontal or sphenoid sinuses unquestionably requires rapid antibiotic treatment. Presently the choice of antibiotic tends toward products active on both Haemophilus producing beta-lactamase and on pneumococci with reduced sensitivity to penicillin having only a low level of resistance.