The paranasal sinuses are empty cavities within the skull lined by mucosa, which serve to both decrease the weight of the skull and provide resonant chambers for voice conduction. Unfortunately, a build-up of fluid and bacteria can occur within the sinuses and cause a condition known as bacterial sinusitis. Most cases of bacterial sinusitis are preceded by a viral upper respiratory tract infection such as the common cold. The symptoms of sinusitis include facial pain, dental pain, purulent rhinorrhea and conjunctivitis. According to "The Atlas of Emergency Medicine," the most common causative organisms are Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, and Moraxella catarrhalis. Most people recover from an attack of acute bacterial sinusitis without treatment. If symptoms last more than seven days, antibiotics may be necessary.
Amoxicillin
Amoxicillin is a semi-synthetic penicillin with mechanism of action similar to penicillin. Bacteria possess cell walls, which are essential for their normal growth and development. The penicillins interfere with the production of the cell wall, leading to death of the bacterial cell. Human cells do not possess cell walls and are, therefore, unaffected. Amoxicillin affects more bacteria than its relative penicillin, but is easily deactivated by resistant bacteria, states "Goodman & Gilman's The Pharmacological Basis of Therapeutics." It is particularly effective against Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes.
Macrolides
The macrolide family of antibiotics includes the drugs erythromycin, clarithromycin and azithromycin. Erythromycin was first discovered in 1952 and was found to prevent bacterial growth by inhibiting bacterial protein synthesis. These medications are commonly used to treat serious lung infections, such as legionnaire's disease, as well as sexually transmitted diseases such as chlamydia. They can be effective against acute bacterial sinusitis and are especially useful in patients who have a penicillin allergy. Unfortunately, "The Pharmacological Basis of Therapeutics" states that resistance to the macrolides is increasing in the bacteria responsible for sinusitis.
Trimethoprim-Sulfamethoxazole
Trimethoprim-sulfamethoxazole, or Bactrim, is a combination of two antibiotics that interfere with different steps of the same enzymatic pathway in bacteria. This pathway is needed to produce the chemical tetrahydrofolate, which is essential for both bacterial and human life. Fortunately, Bactrim does not affect humans because humans obtain the components of these reactions from their diet instead of having to produce them enzymatically. This antibiotic is commonly used to treat urinary tract infections and is effective in cases of acute sinusitis caused by Haemophilus influenzae and Streptococcus pneumoniae. However, "The Pharmacological Basis of Therapeutics" points out that it does not reliably eradicate Streptococcus pyogenes and should not be used to treat infections caused by this organism.
References
- "Goodman & Gilman's The Pharmacological Basis of Therapeutics, 11e"; Laurence L. Brunton, editor-in-chief; 2006
- "The Atlas of Emergency Medicine, 3e"; Kevin J. Knoop, Lawrence B. Stack, Alan B. Storrow, R. Jason Thurman; 2010
- "Harrison's Principles of Internal Medicine, 17e"; Anthony S. Fauci, Eugene Braunwald, Dennis L. Kasper, Stephen L. Hauser, Dan L. Longo, J. Larry Jameson, and Joseph Loscalzo, Eds.; 2008
