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

Diagnos...

...with “persistent” symptoms or signs compati...

...severe” symptoms or signs of high feve...

...worsening” symptoms or signs characte...


Initial Treatment

...recommends empiric antimicrobial therapy be...

...A recommends amoxicillin-clavulanate rather t...

...ecommends amoxicillin-clavulanate...

...nds “high-dose” amoxicillin-clavulanate...

...mmends a β-lactam agent (amoxicillin-clavulanat...

...(clarithromycin and azithromycin) are NOT recomme...

...lfamethoxazole (TMP/SMX) is NOT recommended f...

...be used as an alternative regimen to am...

...ond and third generation oral cephalosporins are n...

...mmends either doxycycline (not suitable for...

...he IDSA recommends levofloxacin for chi...

...ureus (including methicillin-resistant S. aureus...


...n of Treatment...

...mended duration of therapy for uncomplicat...

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


...tive Treatment...

...mmends intranasal saline irrigations with...

...mmends intranasal corticosteroids...

...ical nor oral decongestants and/or antihistamine...


...ondary Treatme...

...IDSA recommends an alternative manageme...

...ted patients who clinically worsen despite...

...IDSA recommends that cultures be obtained by...

...sider endoscopically guided cultures of the middle...

...eal cultures are unreliable and are NO...

...h ABRS suspected to have suppurative compli...

Patients who are: Seriously ill an...


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


...ure 2. Time to Bacterial Eradication From the Ma...


...onventional Criteria for the Diagnosis of Sinusiti...


...ence (Mean Percent of Positive Specimens) of Var...


Treatment

...eatment

...robial Regimens for ABRS in AdultsH...


...robial Regimens for ABRS in ChildrenHavi...


...vailable AntibacterialsHaving trou...


...able 7. Indications for Referral to a S...


...lgorithm for the Management of ABRS...