Acute bacterial sinusitis: current concepts in antibiotic therapy

Abstract

Acute rhinosinusitis is a widespread pathology faced by both outpatient doctors and otorhinolaryngologists in hospitals. At the same time, only understanding of the principles for diagnosing various forms of sinusitis, in particular, the criteria for bacterial sinusitis, provides the adequate treatment decisions. Antibacterial therapy plays a key role in the treatment of patients with acute bacterial sinusitis. Additionally, there is an increasing frequency of the antibiotic resistance of the main bacterial pathogens in the respiratory group of diseases. Both in Russian and foreign clinical guidelines, the so-called lines of antibacterial therapy are clearly identified. Strict adherence to the national recommendations and a thorough analysis of clinical and anamnestic data allows a rational approach to the choice of an antibacterial drug. There is an increase in the rate of uncontrolled and inadequate antibacterial therapy, particularly using of penicillins and short course of macrolides, over the last decade. Such trend is dangerous due to the increased risks for the development of the antibiotic resistance to those groups of antibiotics. Use of dispersible forms is one of the key point of the strategies to overcome the antibiotic resistance. The most important features of dispersible forms of antibiotics are prevented destruction in the stomach and maximal absorption in the upper parts of small intestine. It allows to increase the bioavailability of the drug and to minimize the impact on the intestinal microbiome, which reduces the incidence of common adverse reactions from the gastrointestinal tract. According to literature, oral administration of dispersible forms of drugs allows to reach the plasma concentrations similar to those in parenteral administration.