Sinusitis in the Common Cold
Bacterial sinusitis is generally treated with antibiotics. Sinusitis, as determined, may be of diverse origin. During the common cold, if symptoms suggest sinusitis and sinus films are obtained, sinusitis seen on such films might prompt antibiotic use, as differentiation of bacterial from viral sinusitis is difficult. As part of a trial of fluticasone propionate in treatment of the common cold, Puhakka and associates studied sinus radiographs of 197 young healthy adult men and women on days 1, 7, and 21 of a common cold, and followed patients for three weeks clinically beyond that time.
Radiographs showed sinusitis in 14.2% of patients on day 1, 38.8% on day 7, and 11.3% on day 21. Common radiographic findings included mucosal thickening greater than 5 mm, air-fluid levels, and total opacification.
Overall, 57% of study subjects had sinus abnormalities during the first 21 days. All patients made full clinical recoveries, and no patient with radiologic sinusitis was treated for it with antibiotics.
Sinusitis is common, as defined radiographically, during the common cold. Puhakka et al suggest that, with few exceptions, sinus films should not be obtained during the typical evolution of the common cold, as such films lead to unnecessary irradiation, cost, and likelihood of superfluous antibiotic therapy.
Puhakka T, et al. J Allergy Clin Immunol 1998;102:403-408.
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