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Antibiotics for sinusitis: pros and cons

Sinusitis is an inflammation of the paranasal maxillary sinuses that can be caused by a number of reasons. Therefore, the appearance of characteristic symptoms (long-term pass runny nose with thick mucus, headache, sense of fullness in the infraorbital area) you must visit the doctor, be diagnosed and get expert recommendations. Ignoring the problem, symptomatic measures and self-treatment can result in transition of maxillary sinusitis in the chronic form.

In the majority of cases of this disease are caused by bacteria, therefore, antibiotics for sinusitis – first-line drugs. However, systemic antimicrobial therapy is indicated only in those cases where the patient cannot fight the infection for a long time and the risk of severe complications. Bacteria from the maxillary sinuses through the blood can get into the lower respiratory tract and cause bronchitis or even pneumonia. But the main danger is a proximity of the inflammation to the brain and the possibility of developing meningitis or encephalitis.

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When the sinusitis need antibiotics?

To understand in which cases the use of antibiotics when sinusitis is really necessary, it is necessary to consider the reasons for the development of this disease.

On the etiology of sinusitis is divided into the following categories (in descending order of occurrence):

  • Bacterial – called pneumonia, or pyogenic viridans Streptococcus, Staphylococcus aureus, Haemophilus influenzae, Pseudomonas or Escherichia coli, Moraxella, Klebsiella, chlamydia, Mycoplasma, Proteus, and other pathogenic and conditionally pathogenic microorganisms. Occurs as a resultpenetration of the pathogen into the maxillary sinus from the upper respiratory tract (rhinitis, tonsillitis, pharyngitis), dentition (caries, dental abscess, granuloma of the roots, periodontitis) or General circulation in inflammatory diseases (scarlet fever, measles). Can be unilateral, bilateral, often purulent, catarrhal than (only swelling);

  • Viral – is caused by rhinoviruses, coronaviruses, adenoviruses, enteroviruses, influenza a and B, parainfluenza. Usually occurs on the background of seasonal colds, always bilateral, often catarrhal, sometimes asymptomatic and goes away in 1-2 weeks. In viral sinusitis antibiotics useless, or rather harmful. But at 7-10 days of heavy flu, SARS or acute respiratory disease may be complicated by bacterial infection with accumulation of pus in the maxillary sinuses, and then shows antimicrobial therapy;

  • Mixed is invoked by the complex of reasons, among which may be viruses, bacteria, fungi and allergens. Often shifts from acute to chronic. Almost always bilateral, and combined with the other forms of sinusitis (frontal sinusitis, ethmoiditis and sphenoiditis). Can be of any nature: purulent, catarrhal, serous, exudative. Mixed viral and bacterial sinusitis antibiotics are used, but the selection of the drug must be carried out very carefully on the basis of test results and data history;

  • Allergic – is called the negative reaction to allergens, which are dominated by inhaled particles (household dust, poplar fluff, pollen). Always bilateral, is characterized by severe edema of the mucous membranes, sneezing and rhinorrhea. Antibiotics for sinusitis allergic nature are not necessary, are appointed by antihistamines and is taking measures on elimination of the allergen from the everyday life of the patient;

  • Fungal – called yeast-like microorganisms and fungi on the background of immunodeficiency States in debilitated patients, elderly people and young children. Very rare, sometimes bilateral, is characterized persistent, chronic course, requires a comprehensive approach to treatment. When fungal sinusitis antibiotics are absolutely contraindicated;
  • Drug – called prolonged use of drugs that have a detrimental effect on the mucous membranes of the maxillary sinus and the good functioning of ciliated epithelium,responsible for the evacuation of mucus. Usually occurs on the background of the abuse of vasoconstrictor nose drops. Honoring always bilateral, it can be atrophic (tissue death), hyperplastic (overgrowth of the mucosa) or cystic-polypous (the occurrence of polyps, overlying the mouth of the maxillary sinus). Without secondary bacterial infections such sinusitis, antibiotics do not treated;
  • Traumatic – is called mechanical damage of the maxillary sinus, accumulation of blood and exudate and subsequent inflammation. In this case, the patient is shown the antibiotics, physiotherapy, and sometimes surgery.

What are antibiotics effective in sinusitis?

In order to choose an optimal antibacterial drug for the treatment of sinusitis, the doctor considers the following patient data:

  • History – when and under what circumstances occurred the disease (seasonal flu, systemic infection, hay fever, injury), what is the nature of the symptoms (body temperature, degree of intoxication, severity of pain, the color and consistency of nasal mucus), how long the person was ill, did something to self-treat;
  • The results of examination and tests – x-ray, General blood tests, bacterial seeding;
  • Age and status is a antibiotics for sinusitis are not applicable in children, weak and elderly, pregnant and lactating women;
  • Information about previously used antibiotics – the more often a person is treated the same antibiotics, the less effective it becomes;
  • The presence of Allergy.

On this basis, we can understand that the most effective antibiotics against sinusitis is the drug to which the pathogen is sensitive, no resistance, allergies and contraindications, minimal side effects and harm to the body. Since most modern antibiotics have a very broad spectrum of activity and is active against almost all the microbes that cause sinusitis, the need for bacterial seeding and establishing specific culprit of the disease occurs only in the case when the passed the coursetherapy gave no results.

The most commonly used and effective antibiotics for sinusitis are divided into four groups:

Protected aminopenicillin

It is a synthetic penicillin in combination with special chemicals that neutralizes resistant bacteria. Over many years of active use of penicillins and cephalosporins, many agents have adapted to them and developed an enzyme from the group of beta-lactamase, named "penicillinase", which just destroys the gets in the body, the cure and gives it to fight infection. To avoid this, added to penicillins, sulbactam or klavulanova acid.

Against sinusitis the most effective:

  • Sulbactam ampicillin (Ampicin, Libutil, Unasyn, Sultasin, Albazin, Swazilan, Sultamicillin);
  • Clavulanate amoxicillin (Amoxiclav, Ecolaw, Rapidlab, Flemoklav, Panklav, Augmentin).

This is important: the Usual amoxicillin, which is sold for big money under the trademark flemoksin soljutab, in most cases, sinusitis is not helping.

Protected penicillins exert a bactericidal effect (kill bacteria), and make it targeted, as focus on particular markers of cell membranes of pathogens. In the human body like cell no, so this therapy does not destroy healthy tissue. Penicillins are widely used for the treatment of sinusitis in children. However, this group of drugs is often allergic, and long-term use could upset the balance of the microflora of the internal organs, side effects from the gastrointestinal tract, the development of fungal infections. One drawback of penicillin – short half-life, resulting the tablets have to be taken every 4-6 hours.

Macrolides

Antibiotics of this group are the safest for the person least likely to cause allergies and side effects. In contrast to penicillins, they have a bacteriostatic effect (do not allow bacteria to reproduce), which is very advantageous in resistant, chronic sinusitis. In addition, macrolides effective against obligate intracellular parasites (Mycoplasma, chlamydia), which are also often the cause of sinusitis.

These drugs are very convenient to use as wellaccumulate in tissues and how long they persist. The latest generation macrolides are sold in packages containing only a few capsules. Uncomplicated infections are treated successfully even once. If the patient individual intolerance to penicillins, atypical or mixed form of the disease, macrolides are the effective antibiotics for sinusitis.

The disadvantages include the high cost of some drugs in this group. The use in children, during pregnancy and lactation is possible in the case when the potential risk is lower than the expected benefits.

Macrolides are divided into:

  • 14-membered – Erythromycin, Roxithromycin (Rulid, Kitazin, Elrox, Roxiller, Ravenal), Clarithromycin (Klacid, Klabax, Klaricid, Aconitin, Fromilid UNO);
  • 15-membered Azithromycin and its analogues, called asilidae (Hemomitsin, Sumamed, Azitral, Azitroks, Sitrus, Setrole, Z-factor);
  • 16-membered – Midecamycin (Macropen, Midein), Spiramycin (Rovamycin, Spiramycin), Josamycin (Vilprafen).

Cephalosporins

This is one of the most numerous and long-used groups of antibiotics. They have a bactericidal effect. Today, there are already five generations of cephalosporins. The breadth of antibacterial spectrum, they are not superior to penicillin and more macrolides, but resistant to beta-lactamases – enzymes, which explains the resistance of some pathogens of sinusitis. However, this statement is true in respect not all cephalosporins.

If the patient is allergic to penicillin, it is likely it will have a negative reaction to cephalosporins. Side effects are also similar, treatment of sinusitis in children is possible, during pregnancy and lactation the issue is solved individually. A this group of drugs unsuitable for oral administration because it is not absorbed from the gastrointestinal tract, and greatly irritate the mucous membranes. The advantages of cephalosporins as antibiotics for sinusitis refers affordable price.

This is important: cephalosporins is absolutely incompatible with alcohol because it inhibited the synthesis of the liver enzyme aldehyde dehydrogenase needed to neutralize the toxic breakdown products of ethanol on the body.

Cephalosporins are divided into:

  • 1st generation – Cefazolin (Ozolin, Kefzol, Solvin), Cephalexin (Ecocean, Sporidex, Lexin);
  • 2 generationCefuroxime (Zinacef, Zephyrus, Axetil), Cefoxitin (Anaerocef, Bonnefin, Mefoxin);
  • 3 generation Cefixime (Suprax, Maximat, Loprox), Ceftriaxone (Rocephin, Asaran, Lendacin);
  • 4th generation – Cefpirome (Sodepa, Caranorn), Cefepime (Zeromax, Maxipim);
  • 5th generation – Ceftobiprol (Zeftera), Cephalothin.

Fluoroquinolones

Drugs in this group differ from other antibiotics from sinusitis, because they are fully synthetic and do not occur in nature. Fluoroquinolones have a wide spectrum antibacterial effect, have a very rapid and pronounced bactericidal effect on most pathogens of sinusitis, including atypical forms, is caused by chlamydia or Mycoplasma. However, due to their high toxicity and alien, synthetic origin, they often lead to the development of Allergy and the occurrence of severe side effects from the gastrointestinal tract and nervous system.

Like antibiotics for sinusitis in children fluoroquinolones are considered only in extreme cases, pregnant and nursing women is absolutely contraindicated. Another shortcoming of this group of drugs is the high price, but if you look for the drug the active substance, and not by the known brand, you can save considerably.

Fluoroquinolones are divided into:

  • 1st generation – Ofloxacin (Tarivid, Zanocin), Pefloxacin (Abaktal, Unikem);
  • 2nd generation – Ciprofloxacin (Tsiprolet, Tsifran, Ciprinol, Ciprobay, Ecocidal), Norfloxacin (Nolicin, Normaks, Norbaktin);
  • 3rd generation – Levofloxacin (Glevo, Tavanic, Levester), Sparfloxacin (Sparflo, Respira, Sparbach);
  • 4th generation – Moxifloxacin (Moxin, Avelox, Megaplex), Gemifloxacin (Factive).

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The pros and cons of antibiotics for sinusitis

Best antibiotics sinusitis can be picked up for the smear from the nose. 48 hours after taking the prescribed antibiotic needs to be a positive reaction, otherwise it will need urgent replacement. It is also possible that the antibiotic a pathogen has evolved resistance, or the nature of the sinusitis is not bacterial it is viral, fungal,allergic or combined.

Ceftriaxone from sinusitis

Along with many other antibiotics of the cephalosporin type, Ceftriaxone is considered an effective medication for the treatment of sinusitis. It belongs to the third generation and features a powerful bactericidal effect against the majority of germs that cause sinusitis. Ceftriaxone very often appointed in inflammatory diseases of the nasopharynx, throat, bronchi and lungs. Its efficiency is so high that it is used even for the treatment of sepsis, peritonitis and meningitis.

Pros

The main advantage of Ceftriaxone is the high effectiveness of treatment of bacterial infections, the development of which is urgently required to suspend. Since this antibiotic has a strong and rapid bactericidal effect, it is very well suited for the treatment of acute sinusitis, involving severe pain, fever, large accumulation of pus in the sinuses and severe intoxication of the organism. In such a situation it is bactericidal, not bacteriostatic antimicrobials from sinusitis most effective and faster help to get to his feet.

Another positive aspect of Ceftriaxone is that it is a modern drug that is resistant to beta-lactamases, and therefore, the probability that the causative agent of sinusitis will be resistant to it, approaching zero. The third advantage of Ceftriaxone is affordable to buy powder in vials for injection solution for domestic production can be for 25-50 rubles. Foreign counterparts (Rocephin, Asaran, Lindzen) are from 500 to 2500 rubles.

Cons

The major disadvantage of Ceftriaxone is associated with a greater risk of side effects. Treatment of sinusitis this drug is sometimes accompanied by disorders of the gastrointestinal tract, hepatitis, angioedema, jaundice, and interstitial nephritis. Therefore, the antibiotics of cephalosporin group are not funds of first choice in case of sinusitis. Ceftriaxone is prescribed to pregnant women only if other therapies proved ineffective, and there is a threat to life. In the period of breastfeeding the drug is contraindicated. For the treatment of sinusitis in young children the dose is prescribed individually.

A second obvious disadvantage of Ceftriaxone is the impossibility of oral intake, as this antibiotic, as with many other drugs cephalosporin, almostnot absorbed from the gastrointestinal tract and has a strong irritant effect on mucous membranes. Ceftriaxone administered intravenously or intramuscularly 1-2 times a day and in no case do not mix with calcium solutions. As we mentioned above, cephalosporins absolutely incompatible even with the ethanol.

A third disadvantage of Ceftriaxone as the antibiotic of sinusitis is in many undesirable interactions with other drugs. In a joint application with drugs that reduce platelet aggregation (for example, with the usual Aspirin) the risk of internal bleeding. But when administered simultaneously with loop diuretics exacerbated by nephrotoxicity of Ceftriaxone. Mixing this drug with antibiotics of other groups to enhance the effect is unacceptable.


Augmentin (Amoxiclav) from sinusitis

The drug Augmentin (aka Amoxiclav) is an antibiotic broad-spectrum, providing a powerful bactericidal effect on most pathogens of sinusitis. It belongs to the category semi protected aminopenicillins, which is clavulanic acid – a substance that destroys the enzyme beta-lactamase by which the bacteria try to destroy antibiotics for sinusitis, although it should be the opposite. Popular analogue Augmentin is a drug Amoxiclav: they have absolutely identical chemical composition, but several different price the second option.

Pros

Augmentin – a modern antibacterial drug, was developed by specialists of the British pharmaceutical company SmithKline Beecham Pharmaceuticals, which has a very high reputation in the market, is famous for its high quality and safety of products. It protected semisynthetic aminopenicillin, such as Augmentin Amoxiclav and today are considered the most effective antibiotics for sinusitis because they are not afraid of the acquired resistance of pathogens.

The second obvious advantage of Augmentin is that the antibiotic has a selective bactericidal activity, identifying pathogenic microbes on special markers on their cell membranes. And since the human body do not exist any similar cells in the treatment of sinusitis Augmentinom healthy tissue will not be damaged. That's why protected semisynthetic aminopenicillin the latest generation of the most commonly used in the treatment of diseases of ENT organs in children.

The third distinct advantage of Augmentin is ease of use – maintainingthe therapeutic effect of the drug 2 times a day. In some special cases, showing a single daily intake, or split the dosage into 3-4 doses.

Cons

All the shortcomings of Augmentin and other penicillin antibiotics used to treat sinusitis, centered around side effects. Patients often have nausea and heartburn. There are known cases of liver and kidney. Sometimes develop local allergic reactions, candidiasis and intestinal dysbiosis. Among the disadvantages of Augmentin is difficult not to attribute its high cost.


Sumamed from sinusitis

Sumamed refers to the second generation macrolides with 15-membered azalides – Azithromycin and its analogues. However Sumamed is the most popular drug in this group, as produced in reputable pharmaceutical companies (Teva, Israel and PLIVA HRVATSKA – Croatia), is of high quality and successfully used to treat difficult bacterial infections including sinusitis, for many years.

Pros

The main advantage of Sumamed is the broadest antibacterial spectrum. This antibiotic is effective even in case of atypical sinusitis caused by obligate microorganisms – Mycoplasma and chlamydia. If we are talking about a mixed, multi-factor infection with a chronic course, exactly Sumamed with its bacteriostatic action can stop the inflammation and to prevent remission. This drug prevents the bacteria to multiply, and therefore, as they were not in the body at the time of initiation of therapy, the disease will inevitably stop, because the available agents will gradually destroy cells of the immune system, and new colonies cannot appear.

The second huge plus Sumamed – record the course of treatment of sinusitis (5-7 days) and ease of administration (1 capsule per day). This drug is very good accumulates in the tissues and remains there for a long time, so there's no need to take pills every 4-6 hours, as is the case with many other popular antibiotics from sinusitis.

The third advantage of Sumamed is a relatively small risk of side effects. Only about 10% of patients undergoing treatment of sinusitis this drug, point failures in the gastrointestinal tract (nausea, vomiting, heartburn, dry mouth, discomfort in epigastria, flatulence, diarrhea) or trouble on the part of the nervous system (headache, fastfatigue, insomnia). Allergic reactions and serious diseases of internal organs develop on the background of therapy Sumamed extremely rare.

Cons

The main drawback of Sumamed from sinusitis is the age limit, status and health of the patient. This antibiotic is contraindicated in pregnant and nursing women, children under the age of 12 years (we are talking about capsules for oral administration, for kids produces powder), and people with severe kidney and liver failure and several other serious diseases.

The disadvantages of such an effective antibiotic against sinusitis, as a Sumamed, can be attributed except the high price, but this problem is easily solved by selecting the available analogue. If the original Sumamed is 400-500 rubles, the domestic Azithromycin will cost you a sum of from 80 to 120 rubles, and chronic sinusitis will be cured as effectively.


Macropen from sinusitis

Macropen is the latest, third generation macrolides. The active ingredient of this drug is called midecamycin. Compared with the predecessor, azithromycin, this antibiotic is even less toxic to the human body and has an even more pronounced bacteriostatic effect against the majority of causative agents of sinusitis, atypical, chronic and mixed forms of the disease.

Pros

Continuing to compare Macropen and Sumamed, from the point of view of their effectiveness in the treatment of sinusitis, we note a higher rate of absorption and onset of therapeutic effect in Macropene – after an hour after taking the drug in the patient's blood to set the desired concentration of the substance. However, the half-life midecamycin shorter than that of azithromycin, therefore, to take a more modern antibiotic more often – 3 times a day 1 capsule 400 mg (adults and children weighing more than 30 kg).

The second major advantage of Macropen, not only to other macrolides, but before any antibiotics for sinusitis – minimum risk of unwanted side effects. In very rare cases, patients complain of nausea, diarrhea, hives or headache. The incidence of complications even with long-term use Macropen not exceed 4%.

Cons

The disadvantages of Macropen include limitations on the status and condition of patients: it is not prescribed to people with severe forms of kidney and liver failure and other serious pathologies. However, the same contraindications isabsolutely all antibiotics from sinusitis, so the question of whether therapy should be addressed individually. The same applies to the treatment of sinusitis in pregnant women – the risk must be justified.

The second disadvantage of Macroben – relatively high cost (250-400 rubles), and to find a more affordable counterpart is unlikely. Midecamycin is one of the most modern antibiotics, so the pharmaceutical industry has not yet managed to release a variety of drugs based on it, as is the case with the predecessor, azithromycin.


Flemoksin soljutab from sinusitis

Flemoksin soljutab is the most popular brand produced well-known antibiotic penicillin amoxicillin in form of trihydrate. It is active against the bacteria most commonly causing acute sinusitis (pneumoniae a Streptococcus, Staphylococcus aureus, Pseudomonas aeruginosa, Moraxella, Klebsiella, etc.) and renders them rapid and pronounced bactericidal action.

Pros

The main advantage of Flemoxin lies in its selectivity – destroy only the cells of the pathogen, and tissue of the human body do not suffer from toxic effects of the drug. For this reason, amoxicillin is an antibiotic of the first stage in the treatment of sinusitis, including in young children.

The popularity of tablets flemoksin soljutab in comparison with other brands of amoxicillin for two reasons: first, the trihydrate faster and easier absorbed by the gastrointestinal tract, without causing irritation of the mucous membranes. And secondly, flemoksin soljutab is a handy, easy to break apart into two halves chewable tablets with a pleasant tangerine-lemon flavor.

Cons

About contraindications and side effects of amoxicillin we have already told, when considered Amoxiclav Augmentin and in this respect the drugs are identical. But in their differences lies the main disadvantage Flemoxin. The fact that he is unprotected antibiotic and penitsillinazoy destroyed the enzyme, by which many bacteria successfully "defend" from antimicrobial therapy. Resistance of pathogens of acute sinusitis to the drug flemoksin soljutab in recent years has become commonplace, especially in pediatric patients.

But even if the sinusitis can be treated successfully with amoxicillin unprotected, taking pills will have 3-4 times a day for 7-14 days due to the short periodhalf-life of the active substance from the body. Given the high cost of the drug flemoksin soljutab (600 rubles, depending on the dosage), complete course of therapy will cost a tidy sum.


Izofra in the sinus

Izofra – a local antibacterial drug from sinusitis in the form of a nasal spray. The active component is an antibiotic Isory framizetin, which belongs to the group of aminoglycosides and provides bactericidal activity against some pathogens of sinusitis (Staphylococcus aureus, Escherichia coli and Pseudomonas, Klebsiella, enterobacteria, Proteus). Framizetin is not used orally because it is highly toxic to the human body, however, irrigation of the nasal spray Izofra accompanied by meager absorption of the drug into the blood, so that treatment of sinusitis effectively and safely.

Pros

The main advantage of the nasal spray Izofra in front of other antibiotics against sinusitis is an almost complete absence of contraindications and side effects, because the active substance is not absorbed in the gastrointestinal tract (and therefore can not cause nausea or diarrhea, or stay in the body due to dysfunction of the liver or kidneys) and does not accumulate in the blood (and therefore can not cause allergies or problems with the nervous system).

The undoubted advantages Isotry from sinusitis is the ease of use: a slight press allows you to obtain the exact dose (adults 4-6 times a day, one injection in each nostril, and children 3 times). Izofra has a subtle lemon flavor, so the treatment of sinusitis and rhinitis causes of discontent among the youngest patients. The drug is manufactured in France by a pharmaceutical company Laboratoires BOUCHARA-RECORDATI, who is also known for its effective antiviral drug Polideksa.

Cons

A significant negative Isory – narrow antibacterial spectrum. The fact that framizetin has no bactericidal action on Streptococcus pneumoniae, and this is one of the most frequently diagnosed pathogens of acute sinusitis. Resistant to it and anaerobic bacteria (Peptostreptococcus, Bacteroides species, fuzobakterii), which is also sometimes the cause of sinusitis, especially chronic and constantly relapsing forms. Therefore, it is advisable to conduct short 7-10-day course of treatment of sinusitis Isoroy, and if it fails, move on to another drug.

The disadvantages of spray Izofra can be attributed to the rather high price (250-400 rubles), however, this one of a kindeffective local antibiotic from sinus trouble, so it's worth the money. The only contraindication to its use – damage to partitions and the period after the puncture of the maxillary sinus, as in this case the active substance will penetrate into the blood to an unacceptable extent.


Dioxidine in the sinus

Dioxidine (hydroxymethylhinoxilindioxide) is an antibiotic very wide spectrum of bactericidal action, derived chinoxalin. It is active against all strains of Streptococcus and Staphylococcus, Pseudomonas and E. coli, Shigella, Salmonella and pathogenic anaerobes. The causative agents of sinusitis, exhibiting resistance to other antibiotics, usually can not withstand the onslaught dioksidina, so the drug has been successfully used for the treatment of rhinitis and sinusitis. The optimal form 0.5% solution in ampoules, which should be instilled into the nose.

Pros

The main advantage of Dioksidina, as a local antiseptic in the sinus, lies in the breadth of antibacterial spectrum and rapid rehabilitation of the nasopharynx. Burying 5 drops of solution into each clean nostril 4-6 times a day in a week to count on radical improvement of health in the acute form of the disease.

The second advantage of this drug is relatively affordable price – one bottle will cost you about 50 rubles. However, be aware that after opening it cannot be stored in the refrigerator more than one day. Therefore, a complete treatment of sinusitis this antiseptic, most likely, will leave the whole pack of 10 vials.

Cons

Dioxidine is extremely toxic, and it is absorbed into the bloodstream through the mucous membranes in intra application solution in amounts sufficient for the development of side effects. Therefore, the official instruction for the drug States that it is contraindicated for pregnant and lactating women and children up to 18 years. But, despite this, many practitioners ENT doctors prescribe this antibiotic to treat sinusitis, even the kids of 3-4 years. How to take such advice is a personal choice of the parents.

Minus the second Dioksidina lies in the fact that by itself it doesn't cure the sinusitis completely, so always assigned in the combined antibacterial therapy. That is, you have not only instilled into the nose of potentially dangerous (and, incidentally, terribly bitter) fluid, but also to take the antibiotics orally or injecting. It is obvious that this approach to the treatment of sinusitis is justified only in case of a severe, complicated course of the disease and a real threathealth.