James R. Johnson, MD
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Johnson JR. Principles of Judicious Antibiotic Use: Acute Rhinosinusitis. Ann Intern Med. 2002;136:708-709. doi: 10.7326/0003-4819-136-9-200205070-00017
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Published: Ann Intern Med. 2002;136(9):708-709.
TO THE EDITOR:
According to the background paper by Hickner and colleagues on antibiotic use in acute rhinosinusitis (1), “The greatest barrier to efficient antibiotic treatment of acute bacterial rhinosinusitis is lack of a simple and accurate diagnostic test.” This and the accompanying guideline (2) do not mention the possible utility of the Gram stain. Dr. Bartlett, a coauthor of the Hickner paper, has advocated use of the sputum Gram stain in patients with community-acquired pneumonia (3). Since the gold standard for bacterial rhinosinusitis is more than 105 colony-forming units per mL of bacteria in purulent sinus fluid (1), a Gram stain of nasal secretions showing many neutrophils and bacteria should be predictive. The authors' opinions regarding the available data or the need for further study of Gram stains in rhinosinusitis would be welcome.
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