Contribution to the study of the bacterial flora of sinusitis; evaluation of its sensitivity to antibiotics

Abstract

The authors, after general considerations regarding the bacteriology of the nose and paranasal sinuses in normal and infected patients, emphasize a fact of common verification, which is the progressively frequent occurrence of resistence in acute and chronic infections of the upper respiratory tract to penicillin and other antibiotics. A culture was made of the sinus exudate of 45 patients with sinusitis and the nasal mucus of 25 clinically normal patients. The organism found was isolated, identified and submitted to tests of sensitivity to the following antibiotics: penicillin, streptomycin, chloramphenicol, aureomycin and terramycin. Tests were performed by the disk method. The sinus exudate was obtained in three different ways: 1. from the sinus cavity by trepanation of the anterior wall (Caldwell-Luc); 2. by the puncture of the inferior meatus; 3. by aspiration of the middle meatus. In the normal patients, the mucus was removed from the middle meatus with a platinum wise and planted directly into the medium. A comparative study between the organisms found in the infected and in the normal patients shows a sharp difference in both florae. In the former there were a predominance of Staphylococcus, Haemophilus, Pneumococcus and Streptococcus viridans; in the latter, Staphylococcus and difteroides appeared most frequently, with absence of the other organisms. The sensitivity tests were performed on all the organisms with penicillin and chloramphenicol, with the other antibiotics tests were made in part of the material. Chloramphenicol presented the greatest activity against the Grampositive cocci. Penicillin was uniformly active against Streptococcus and Pneumococcus, but unefective in a great percentage of the sthaphylococci.