[Community-acquired acute maxillary sinusitis or rhinosinusitis in adults in France: current management]. / Etat actuel de la prise en charge de la sinusite ou rhinosinusite maxillaire aiguë communautaire de l'adulte en France.

Sinus infections, often viral, are a common reason for physician visits. The multiplicity of clinical presentations makes its diagnosis difficult. The problem is to recognize bacterial infection without additional testing, except in cases of treatment failures, complications or relapse. Patients with signs suggestive of rhinosinusitis fall into one of four basic clinical situations: common colds, 'doubtful' rhinosinusitis, apparent acute maxillary bacterial rhinosinusitis, and complications. Anterior rhinoscopy may help confirm diagnosis. Current bacterial epidemiology is based on the results of clinical studies, microbial ecology, and samples taken in cases of treatment failure. The two bacteria isolated most frequently are Streptococcus pneumoniae and Haemophilus influenzae, both of which pose resistance problems. Moraxella catarrhalis, Streptococcus pyogenes and Staphylococcus aureus are isolated less often. The dominant issue in management of acute rhinosinusitis is whether to use antibiotic or symptomatic treatment. For viral infections, antibiotic therapy is useless and highly inadvisable. For 'doubtful' infections, symptomatic treatment is likely to lead to recovery. The use of non-recommended antibiotics also increases the risk of selection of resistant bacteria. When bacterial rhinosinusitis is strongly suspected, recourse to antibiotic treatment is recommended in view of the benefits in this situation (AFSSAPS 2005). This treatment is probabilistic, should be decided at the end of the consultation, and follows the AFSSAPS guidelines.

[Acute sinusitus in adults. Management by general practitioners]. / Sinusites aiguës de l'adulte. Prise en charge par les médecins généralistes.

OBJECTIVE: Acute sinusitis is a common condition encountered in general practice and raises the question of appropriate management. Sufficient data are still lacking in the literature to provide a fully satisfactory response. METHODS: We conducted a survey among 193 physicians representative of the general practitioners in France to collect 755 cases of acute sinusitis treated in the outpatient setting from January 6 through March 15, 1999. We recorded clinical features and therapeutic management. RESULTS: Pain was the predominant clinical sign (97% of the patients). Facial pain with a highly suggestive localization and aggravated by pressure and headache were the most frequent. Most of the patients also had a nasal symptom (77%) and an infectious context (90%). Three circumstances had been pre-defined by the experts: unique acute sinusitis, acute episode of chronic sinusitis, and recurrent acute sinusitis. In 67% of the cases of unique acute sinusitis, the diagnosis of the general practitioner was confirmed a posterori by the experts. Few complementary tests were ordered (in 17% of the patients) mainly in fragile patients and mainly limited to a radiography of the sinus (81% of the complementary tests ordered). An oral antibiotic was almost always prescribed (96% of the patients) although antibiotics comprised only 29% of all prescriptions. General corticosteroid therapy (41%), local treatment (73%) and anti-cough or expectoration medications (52%) were also prescribed. Despite the painful nature of sinusitis, analgesics were only prescribed for 36% of the patients. CONCLUSION: This observational survey enabled us to describe the diagnostic and therapeutic strategy used by French general practitioners for acute sinusitis in adults. There was general agreement on the strategy that was well adapted to the patient profiles. An evaluation of the different classes of drugs prescribed, and their efficacy in the outpatient setting, that remains to be determined, was not however attempted.