Medical Management of Sinusitis: Educational Goals and Management Guidelines

Abstract

The primary goal of sinusitis management is resolution of infection, leading to patency of the ostiomeatal complex. Antibiotics and decongestants are the cornerstones of therapy for acute sinusitis. Diagnosis of acute sinusitis is based on the history and physical findings. Sinusitis is considered to be acute or recurrent acute if infection resolves without residual mucosal damage. Choices for first-line antibiotic therapy include adequate dosages of trimethoprim-sulfamethoxazole, loracarbef, and amoxicillin-clavulanate. Decongestants and mucoevacuants may reduce tissue edema, facilitate drainage, and maintain ostial patency. Topical corticosteroids are useful additional therapy in allergic rhinosinusitis and as an aid in the long-term management of chronic sinusitis. Parenteral corticosteroids have no role in first-line management of acute or recurrent acute sinusitis.