Microbiology and management of chronic maxillary sinusitis

Arch Otolaryngol Head Neck Surg. 1994 Dec;120(12):1317-20. doi: 10.1001/archotol.1994.01880360015003.


Objective: Assessment of the microbiology and management of patients who suffered from chronic maxillary sinusitis was studied retrospectively.

Design: Retrospective analysis of microbiology and antimicrobial therapy of 68 patients who underwent the Caldwell-Luc procedure for chronic sinusitis had not received antimicrobials before surgery and whose cultures showed bacterial growth.

Setting: This study was performed at the Naval Hospital in Bethesda, Md.

Intervention: Amoxicillin-clavulanic acid was given to 18 patients, amoxicillin or ampicillin to 25, cefaclor to 17, and erythromycin to eight.

Results: A total of 183 isolates (123 anaerobic and 60 aerobic) were recovered. Anaerobic organisms only were recovered from 35 (51%), specimens, and aerobic or facultative bacteria only in 12 (18%), and mixed aerobic and anaerobic flora in 21 (31%). Thirty-four aerobic and anaerobic beta-lactamase-producing bacteria were isolated from 28 patients. The 18 patients who received amoxicillin-clavulanic acid had the most rapid and complete response to therapy, none required a change in therapy, and surgical drainage was required in one case. Of 25 patients who received amoxicillin or ampicillin, eight required a change of therapy due to clinical failure (32%), including three who also had surgical drainage. Of 17 that received cefaclor, five had an antibiotic change (29%), one with surgical drainage. Of the eight who were treated with erythromycin, three needed antibiotic change (38%), two with surgical drainage. Resistant organisms were recovered from most of the patients that required therapeutic change.

Conclusions: These findings indicate the major role of aerobic and anaerobic beta-lactamase-producing bacteria organisms in the polymicrobial etiology of chronic maxillary sinusitis and illustrate the superiority of therapy effective against these bacteria.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Chronic Disease
  • Combined Modality Therapy
  • Drainage*
  • Female
  • Humans
  • Male
  • Maxillary Sinusitis / diagnostic imaging
  • Maxillary Sinusitis / epidemiology
  • Maxillary Sinusitis / microbiology*
  • Maxillary Sinusitis / surgery*
  • Microbial Sensitivity Tests
  • Middle Aged
  • Premedication*
  • Radiography
  • Retrospective Studies
  • Treatment Outcome


  • Anti-Bacterial Agents