Treatment of maxillary sinusitis.

Most patients with sinusitis are treated by general practitioners. Since these doctors generally do not puncture the maxillary sinus, they can not be certain that the patient has a purulent sinus infection, which is the most important sign for determining whether or not the patient should have an antibiotic. Thus, the doctor has to rely on symptoms that are most characteristic of a purulent sinusitis. The symptoms are described and the bacteria most frequently seen in sinusitis are mentioned (Haemophilus influenzae, Streptococcus pneumoniae and anaerobic bacteria). Treatment of maxillary sinusitis should primarily consist of restoring the normal milieu within the sinus by antral puncture and lavage. Penicillin V is still the first antibiotic drug of choice, because of its effectiveness in vitro and in vivo. In therapeutic failure, aeration of the maxillary sinus is first recommended. Cefaclor, tetracyclines or trimethoprim are recommended in patients allergic to penicillins. The agents are also recommended when beta-lactamase-producing strains of H. influenzae and Branhamella catarrhalis are isolated.