What should the family doctor or internist do when a patient fails to respond to initial therapy?
Patients who fail to respond to initial antibiotic therapy for bacterial sinusitis should have a limited CT scan of the sinuses, and a consultation should be made with an otolaryngologist. This specialist will usually perform a nasal endoscopic evaluation and possibly obtain a specimen for culture and sensitivity. If the CT scan shows no fluid accumulation that would require surgical drainage, a change of antibiotic may be considered. Good second-line agents include Augmentin, Zithromycin, Ceftin, Cefuroxime, Gadifloxacin, and Moxifloxacin.
