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Cefaclor vs Amoxicillin in the Treatment of Acute, Recurrent, and Chronic Sinusitis
Werner Huck, M(ASCP);
Barbara D. Reed, MD, MSPH;
Richard W. Nielsen, MD;
Robert T. Ferguson, MD;
Dean W. Gray, MD;
Glen K. Lund, MD;
Dean H. ZoBell, MD;
Mary Beth Moster
Arch Fam Med. 1993;2(5):497-503.
Abstract
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Background
The treatment of acute, recurrent, and chronic sinusitis remains controversial because of the presence of a wide variety of aerobic and anaerobic bacteria in the sinuses.
Design
This double-blind, randomized trial compared cefaclor with amoxicillin in the treatment of acute, recurrent, and chronic maxillary sinusitis using clinical evaluation, roentgenography, and microbiologic evaluation of antral aspirates.
Setting
Outpatient office of five otorhinolaryngologists in Salt Lake City, Utah.
Patients
One hundred eight adult patients with acute, recurrent, or chronic maxillary sinusitis.
Intervention
Oral treatment with cefaclor (500 mg) twice daily or amoxicillin (500 mg) three times daily for 10 days.
Main Outcome Measure
Clinical response to treatment with cefaclor vs amoxicillin.
Results
Fifty-six patients with acute sinusitis, 25 with recurrent sinusitis, and 15 with chronic sinusitis were evaluable. Although multiple organisms were common in each group, patients with acute sinusitis were more likely to have Haemophilus influenzae or Streptococcus pneumoniae, and patients with recurrent or chronic sinusitis were more likely to have anaerobes in sinus aspirate. Whether treated with cefaclor or amoxicillin, clinical improvement occurred in 86% of patients with acute sinusitis and 56% of patients with recurrent sinusitis. Patients with chronic sinusitis were too few to allow statistical analysis of the differences in outcome between them and patients with recurrent or acute sinusitis. Resistance of the cultured organisms to the study drug used was unrelated to treatment outcome.
Conclusions
The rate of clinical improvement was high in patients with acute sinusitis but was less favorable in those with recurrent and chronic disease regardless of the study drug used. The susceptibility of organisms isolated to the study drugs was unrelated to outcome.
Author Affiliations
From Advanced Clinical Microbiology/Research, Salt Lake City, Utah (Mr Huck); the Department of Family Practice, University of Michigan, Ann Arbor (Dr Reed); the Ear, Nose, and Throat Center of Salt Lake City (Utah) (Drs Nielsen, Ferguson, Gray, Lund, and ZoBell); and Lilly Research Laboratories, Eli Lilly & Co, Indianapolis, Ind (Ms Moster).
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ABSTRACT
Bacteriology and {beta}-Lactamase Activity in Acute and Chronic Maxillary Sinusitis
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ABSTRACT
DRUG SUSCEPTIBILITY SHOWS LITTLE EFFECT IN SINUSITIS
JWatch General 1993;1993:3-3.
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