Rhinosinusitis

Publication Date: April 15, 2012

Key Points

Key Points

Rhinosinusitis is an extremely common condition.
  • In a national health survey conducted during 2008, nearly 1 in 7 (13.4%) of all
  • non-institutionalized adults ≥18 years were diagnosed with rhinosinusitis within the previous 12 months.
  • Incidence rates among adults are higher for women than men (~1.9-fold), and adults between 45 and 74 years are most commonly affected.
Rhinosinusitis can be caused by various inciting factors including allergens, environmental irritants, and infection by viruses, bacteria and fungi.

The prevalence of a bacterial infection during acute rhinosinusitis is estimated to be 2% to 10%, while viral causes account for 90% to 98%.

A recent national survey of antibiotic prescriptions for upper respiratory infection (URI) in the outpatient setting showed that antibiotics were prescribed for 81% of adults with acute rhinosinusitis, despite the fact that ~70% of patients improve spontaneously in placebo-controlled, randomized clinical trials. Thus, over-prescription of antibiotics is a major concern in the management of acute rhinosinusitis, largely due to the difficulty in differentiating acute bacterial rhinosinusitis (ABRS) from a viral URI.

Diagnosis

...iagnosis...

Onset with “persistent” symptoms or sign...

...with “severe” symptoms or signs of high...

...orsening” symptoms or signs characteriz...


...tial Treatme...

...A recommends empiric antimicrobial therapy...

...commends amoxicillin-clavulanate rathe...

...ends amoxicillin-clavulanate rather than am...

...ecommends “high-dose” amoxicillin-clavula...

...ommends a β-lactam agent (amoxicillin-clavulanate...

...crolides (clarithromycin and azithromycin) are N...

Trimethoprim/sulfamethoxazole (TMP/SMX) is NOT rec...

...line may be used as an alternative regi...

...and third generation oral cephalospo...

...ommends either doxycycline (not suitabl...

...recommends levofloxacin for children wit...

...eus (including methicillin-resistant S. au...


...ration of Treat...

The recommended duration of therapy for...

...en with ABRS, the IDSA still recommends a long...


...djunctive Treatme...

...mmends intranasal saline irrigations with...

...SA recommends intranasal corticosteroids as a...

...r topical nor oral decongestants and/or antihis...


...ndary Treatment

...mends an alternative management str...

...ts who clinically worsen despite 72 hours,...

...he IDSA recommends that cultures be obtained b...

Consider endoscopically guided cultures of...

...cultures are unreliable and are N...

...ients with ABRS suspected to have suppurative...

...are: Seriously ill and immunocompromised...


...e 1. The Natural History and Time Course of...


...gure 2. Time to Bacterial Eradication From the...


...e 1. Conventional Criteria for the Diagnosi...


...e 2. Prevalence (Mean Percent of Posi...


Treatment

...atment...

...le 4. Antimicrobial Regimens for ABR...


...Antimicrobial Regimens for ABRS in...


...vailable AntibacterialsHaving trouble vie...


...7. Indications for Referral to a Specia...


...ithm for the Management of ABRS...