Controlling acute bacterial maxillary sinusitis.

In acute maxillary sinusitis, after an initial viral episode, bacterial infection can be demonstrated using specific investigations and bacterial isolation. In the vast majority of cases, however, the diagnosis is presumptive. Symptomatic treatments tend to reduce pain and inflammation for easier pus drainage. The decision for or against antibiotic therapy continues to be a matter of debate. Many antibiotics have been used but modern guidelines have established recommendations for the choice and duration of treatments, based on (i) knowledge of pathogens and of their resistance profiles; (ii) improved understanding of the pharmacology of antibiotics, guiding doses and administration routes; (iii) comparative double-blind studies, evaluating antibiotics versus placebo and beta-lactams versus macrolides. Use of newer drugs (fluoroquinolones, ketolides) must be discussed in terms of cost and efficacy.