In the treatment of routine sinus infections, some European studies have shown three to five days of “basic” antibiotics to be effective, so why do so many clinicians in this country still recommend 10 days? Studies also show that at 14 days, the cure rate is the same as with placebo, so how do we know which infections to treat and for how long? How effective are regular sinus x-rays for diagnosing sinus infection, since many simply report mucosal thickening?
—Craig Freyer, MD, Ft. Worth

It is true that recent European studies have shown little difference in outcome when uncomplicated rhinosinusitis is treated with placebo or empiric antibiotics. This is probably because most cases are viral in etiology and would resolve without antibiotics. Radiographs are insensitive for the diagnosis of sinusitis, and the CDC does not recommend their use.

Consequently, expert panels in the United States recommend that a clinical diagnosis of bacterial sinusitis be based on symptom duration greater than seven days. The antimicrobial spectrum should be narrow, since Streptococcus pneumoniae and Hemophilus influenzae are the most common bacterial pathogens, and length of therapy should be seven days (Ann Intern Med. 2001;134:498-505).
—Cedric W. Spak, MD (101-18)

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