Introduction
Sinusitis is an acute or chronic inflammation of the mucous membrane of the paranasal sinuses. Such an inflammation can be viral or bacterial and is often accompanied by rhinitis (runny nose) or pharyngitis (inflammation of the throat). The inflammation is classified according to its location, course and origin, and thus distinguished. If all paranasal sinuses are affected at the same time, it is called pansinusitis.
Antibiotic therapy
Antibiosis is a drug treatment with antibiotics that aims to destroy microorganisms such as bacteria and fungi. Primarily, however, bacteria are the target of antibiotics. Antibiotics are powerless against viruses, so not every sinusitis can be treated with antibiotics.
Antibiotics still differ in their spectrum of action, so not every antibiotic is effective against every bacterium. In fact, the opposite is true: many bacteria are resistant to certain classes of antibiotics. Therefore, antibiotic therapy of sinusitis is only effective and sensible if bacteria are the cause of the inflammation and, at best, it is known which bacterium is involved.
Only then can a targeted therapy be carried out. However, bacterial infections are only the cause in 25-30% of acute sinusitis. In most cases, the inflammation is viral.
There are indications, however, that may indicate a bacterial infection: Complaints on both sides tend to indicate a viral cause. If the bacterial cause is confirmed or strongly suspected, antibiotic therapy can be initiated. Likewise with chronic nasal sinus inflammations in the long-term therapy additionally to other therapy approaches antibiotics are prescribed.
The type of antibiotic depends on the bacterial pathogen present. In most cases it is staphylococci, streptococci, hemophilus influenzae and pneumococci that cause sinusitis.
- On the one hand, this means a duration of illness of over 7 days,
- A unilateral purulent nasal discharge
- As well as unilateral facial pain, which manifests itself in the typical feeling of pressure that one feels in sinusitis.
Overview of potentially effective antibiotics
An overview of potentially effective antibiotics follows:
- Antibiotics that are effective against staphylococci Staphylococci are gram-positive bacteria that can cause sinusitis in addition to many other diseases. In particular, the germ Staphylococcus aureus is involved, which is found in 30% of all people in the nasal entrance, the main nasal cavity and the pharynx. In very severe cases (this generally applies), the bacterial infection can also spread to neighboring bone structures and thus cause damage to the eyes or brain, for example.
Staph. Aureus can also cause meningitis (inflammation of the meninges). Staphylococci are generally naturally resistant to penicillin, making it ineffective.
Therefore, one treats mainly with cephalosporins of the 1st and 2nd, but also of the 3rd generation. Otherwise, penicillin can also be given in combination with a penicillinase inhibitor such as clavulanic acid. This penicillinase inhibitor inhibits the enzyme of the bacteria, which would otherwise destroy the penicillin.
Meanwhile, about 20% of Staphylococcus strains are also capable of forming other resistances, so that one can distinguish from methicillin- and oxacillin-resistant Staph. Aureus and Staph. epidermidis strains.
They are commonly known as the multi-resistant germs MRSA and MRSE. Glycopeptides such as vancomycin are found here. The treatment can take up to 4 weeks, depending on the severity of the infection and the course of the disease.
- Antibiotics that are effective against streptococci Streptococci are also Gram-positive bacteria, whose incubation period (time between infection and first appearance of symptoms) is about 2 to 4 days.
In contrast to staphylococci, they are almost always sensitive to penicillin, so that treatment with penicillin is recommended here. In most cases, treatment with the drug is continued for 10 days. If the course of the disease is very severe with sepsis (blood poisoning), meningitis or existing endocarditis, the therapy is administered in high doses parenterally.
In cases of penicillin allergy, macrolide antibiotics such as erythromycin and clarithromycin can be administered.
- Antibiotics that are effective against pneumococci: These pathogens are similar to streptococci and cause both exogenous (from outside the body) and endogenous (from inside the body) infections.They can therefore be transmitted by droplet infection, or they can trigger an infection from the throat where they are located. The most common causes are sinusitis, otitis (inflammation of the ear), canaliculitis (inflammation of the lacrimal duct) and conjunctivitis (inflammation of the conjunctiva). They also cause pneumonia (inflammation of the lungs).
There are several different subspecies of the germ, against some of which one can be vaccinated. If one is ill, there are some antibiotics that are suitable for treatment. Usually one prescribes 3rd generation cephalosporins.
These are also effective in the dreaded complication of crested meningitis. Otherwise, penicillins and gycopeptides such as vancomycin are also a possibility for treatment.
- Antibiotics that are effective against hemophilus influenzae: This bacterium is a gram-negative rod, which is also found to a small extent in the throat. It causes similar diseases to pneumococci, but is less frequently the cause than pneumococci.
In addition to sinusitis, Haemophilus influenzae typically causes otitis (inflammation of the ear), canaliculitis (inflammation of the lacrimal duct) and conjunctivitis (conjunctivitis), purulent bronchitis (inflammation of the bronchi) and epiglottitis (inflammation of the epiglottis). Meningitis, sepsis and pneumonia can also occur. In rare cases, this germ can develop resistance to penicillin. Augmentan, a macrolide antibiotic or cephalosporins of the 2nd and 3rd generation are therefore preferred. Augmentan is a combined preparation containing the antibiotic amoxicilin and the penicilinase inhibitor clavulanic acid.