Treatment of Bacterial Sinus Infection in Living Kidney Donor Prior to Scheduled Surgery
The bacterial sinus infection must be treated with antibiotics and fully resolved before proceeding with kidney donation surgery to minimize surgical site infection risk and ensure optimal donor safety.
Immediate Management Approach
Antibiotic Selection and Duration
Amoxicillin should be prescribed as first-line therapy for acute bacterial rhinosinusitis in most adults, with treatment duration of 10-14 days to ensure complete resolution before surgery 1, 2.
High-dose amoxicillin-clavulanate (4g amoxicillin/day with 250mg clavulanate/day) is an alternative first-line option that provides broader coverage against beta-lactamase-producing organisms including Haemophilus influenzae, Moraxella catarrhalis, and resistant Streptococcus pneumoniae 3, 4, 5.
For penicillin-allergic patients, respiratory fluoroquinolones (levofloxacin 500mg once daily for 10 days, or moxifloxacin) are appropriate alternatives with 90-92% predicted clinical efficacy 6, 5, 7.
Second-generation cephalosporins (cefuroxime, cefpodoxime, cefdinir) represent additional options for penicillin-allergic patients or treatment failures 3, 4.
Surgical Timing Considerations
Surgery should be postponed until the infection is completely resolved, as active bacterial infection at the time of surgery significantly increases surgical site infection risk 1.
The patient should be reassessed 7 days after initiating antibiotic therapy to confirm clinical improvement; if symptoms worsen or fail to improve, the diagnosis should be reconfirmed and antibiotic therapy changed 1, 2.
Antibiotic prophylaxis for surgery should be administered within 120 minutes prior to incision once the sinus infection has resolved and surgery is rescheduled 1.
There is no evidence supporting postoperative antibiotic prophylaxis beyond the perioperative period 1.
Diagnostic Confirmation
The diagnosis of acute bacterial rhinosinusitis should be confirmed when symptoms persist for 10 days or more beyond onset of upper respiratory symptoms, or when symptoms worsen within 10 days after initial improvement (double worsening) 1, 2.
Radiographic imaging is not routinely necessary for uncomplicated acute bacterial sinusitis unless complications or alternative diagnoses are suspected 1, 2.
The most common bacterial pathogens in acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 3, 4, 5.
Critical Pitfalls to Avoid
Do not proceed with surgery while the patient has active bacterial infection, as this violates fundamental principles of surgical site infection prevention and places the donor at unnecessary risk 1.
Avoid premature assessment of treatment failure before 7 days, as fluctuations in symptoms within the first 48-72 hours are common and do not necessarily indicate treatment failure 1.
Do not use postoperative antibiotics beyond the perioperative prophylaxis period, as there is no evidence supporting this practice and it promotes antimicrobial resistance 1.
Ensure adequate treatment duration before surgery; incomplete treatment may result in persistent infection that increases perioperative complications 1, 2.
Coordination with Transplant Team
The transplant surgery team must be informed immediately about the active infection and need for treatment completion before proceeding 1.
Document complete clinical resolution of sinusitis symptoms before rescheduling surgery 1, 2.
Consider that underlying patient factors in kidney donors (generally healthy individuals) favor good antibiotic response, but renal function should be normal and not affect drug disposition 1.