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Summary: A 2-year-old male, otherwise healthy, suffered a total of 7 episodes of recurrent right-sided periorbital celluitis (POC) which began at 11 months of age. Five of the 7 episodes of right eye swelling/erythema required hospital admission for intravenous antibiotics. Imaging studies demonstrated a well-defined dehiscence in the lamina papyracea. Endoscopic sinus surgery was performed and an abnormal uncinate process was visualized, fused to the lateral nasal wall and ethmoid bulla. Post-operatively, the patient had no further infections. Nasal endoscopy and high-resolution imaging in pediatric patients with recurrent POC could identify those who would benefit from early surgical intervention. [Copyright &y& Elsevier]

Abstract: Acute ethmoiditis are bacterial infections of ethmoid sinuses, which may spread to the orbital or the endocranial spaces. It is essential to fit the antibiotherapy to the bacteria responsible for these infections. Population and methods. – The charts of children hospitalized from 1995 to 2003 for an acute ethmoiditis were reviewed, particularly the results of bacterial exams and the antibiotics delivered. Results. – Over this 9-year period, 125 children (mean age 4.5 years) were hospitalized for acute ethmoiditis. Eighty were checked for blood cultures, which were sterile in 73 cases, and in the other cases, grew Staphylococcus, S. Pneumoniae or Streptococcus pyogenes. Seric soluble antigens were absent in the 5 cases where they were looked for. Ten children had a puncture of a subperiostal abscess: it was sterile in 5 cases, Staphylococcus was found in 4 cases, S. pneumoniae in the last case. Most children received an association of cefotaxim and fosfomycine for a mean duration of 5.6 days. Thirteen per cent of the children received 3 or 4 antibiotics. Discussion. – It is always difficult to found the bacteria responsible for an acute ethmoiditis. In our serie as in others, the most frequent bacteria were Staphylococcus, S. pneumoniae and S. pyogenes. Conclusion. – In view of the bacteria responsible for these infections and their antibiotic resistance, we suggest the association of cefotaxim and fosfomycin for the first line of treatment of acute ethmoiditis. [Copyright &y& Elsevier]

Abstract: Objectives. – The authors had for aim to evaluate the efficacy and tolerance of oral levofloxacin (500 mg once a day during ten days), as a treatment for acute bacterial sinusitis at risk for complications in adult patients. Patients and methods. – This was a prospective, multicenter, open, non-comparative, efficacy and tolerance study of levofloxacin in acute sinusitis at risk for complications, radiologically confirmed, and with documentation of the bacterial origin by fiberoptic rhinoscopy. Results. – Two hundred and thirty-one patients were included and 174 patients had an X ray confirmed sinusitis. The localization was frontal in 81% patients, sphenoidal in 9.2%, ethmoidosphenoidal in 2.3%, and 7.5% patients had a pansinusitis. One hundred and thirty-three patients had a probable or proven bacterial infection, involving: Streptococcus pneumoniae (26.0%), enterobacteriaceae (19.7%), Haemophilus influenzae (17.3%), Staphylococcus aureus (15.0%), streptococci other than S. pneumoniae (7.9%), and Branhamella catarrhalis (5.5%). One hundred and one patients constituted the per protocol population. Clinical success was observed in 94.1 % patients (95/101), and 85.1% (86/101), respectively 7 to 14 days and three to four weeks after the end of treatment, with consistent success rates according to the localization of the infection, and the various pathogens involved. The tolerance data was as expected for levofloxacin. Conclusions. – The results of this study show that levofloxacin, (one 500 mg tablet QD during ten days) is efficient in over 94% patients with bacteriologically documented sinusitis at risk for complications. [Copyright &y& Elsevier]

Objectives: The authors had for aim to evaluate the efficacy and safety of moxifloxacin 400 mg tablets, administered once daily for 7 days in the treatment of acute maxillary sinusitis after first-line therapy failure and acute sinusitis with high risk of complications.Methods: Two hundred and fifty eight patients with radiologically confirmed acute sinusitis were enrolled in this prospective, multicenter study by 52 ENT specialists. Two-hundred and sixteen patients (83.7%) qualified for per-protocol efficacy analysis: 175 in group 1 and 41 in group 2 (frontal: 24, pan-sinusitis: 15, and sphenoid: 2). Pre-therapy cultures were systematically performed at the middle meatus and repeated at day 3–4 of therapy and, if necessary, after the end of therapy. Ninety-two patients (42.6%) qualified for the microbiological analysis.Results: Clinical cure was observed 7–10 days post-therapy in 92.6% of the cases. The most frequently isolated organisms were: Streptococcus pneumoniae (29.4%), Haemophilus influenzae (26.5%), Enterobacteriaceae (17.6%), and Branhamella catarrhalis (11.8%). Bacteriological eradication at day 3–4 of therapy was obtained in 95.7% of patients. At 7–10 days post-therapy, 97.2% of patients who failed to respond to a previous antibiotic and 95.2% of patients who had sinusitis with high risk of complications, were considered as bacteriological success. In total, 12.2% (31/255) of patients experienced drug-related adverse events, abdominal pain (2.4%), nausea (2.4%), and diarrhea (1.2%).Conclusions: Moxifloxacin therapy resulted in a rapid bacteriological eradication and a high rate of clinical cure. [Copyright &y& Elsevier]