The bacterial flora in complications of acute and chronic paranasal rhinogenous sinusitis

Objectives: Complications of infections of the paranasal sinuses (orbital and cerebral complications, frontal osteomyelitis) require a large-dose antibiotic therapy in addition to an immediate operation, covering the complete expected bacterial flora. According to the history and clinical findings, we made a distinction between complications of acute and chronic infections. Patients and Methods: The bacterial flora of altogether 58 cases with complications was analysed. Results: In 21 patients with complications of acute paranasal sinusitis, exclusively streptococci, staphylococci and anaerobes were detected; in the 37 patients with chronic disease, a high rate (43%) of problem bacteria - Pseudomonas aeruginosa and enterobacteria - was found. The proportion of anaerobes was distinctly lower in the chronic sinusitis group (13.5%) than in the group with acute sinusitis (38%). The proportion of mixed infections was distinctly higher in complications of chronic paranasal sinusitis (64.8%) than in acute sinusitis complications(42.8%). Given the different bacterial flora the antibiotic treatment has to be adjusted accordingly, above all taking into account the high rate of Pseudomonas and enterobacteria in the complications of chronic paranasal sinusitis. Conclusions: for the antibiotic therapy of complications of acute sinusitis we recommend: amoxycillin + clavulanic acid or sulfamicillin; even oral cephalosporins las cephaclor, cefuroxime axetil, cefpodoxime proxetil) combined with clindamycin are possible. In complications of chronic sinusitis only a combined therapy is successful. Fluoroquinolones + metronidazole/clindamycin are the first choice; piperacillin or cefotaxime combined with metronidazole as well as clindamycin or meropenem or imipenem are second.