Rhinosinusitis
Key Points
Key Points
- 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.
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
...Diagnosis...
...“persistent” symptoms or signs compati...
...severe” symptoms or signs of high...
...worsening” symptoms or signs characteriz...
...Initia...
...e IDSA recommends empiric antimicrobial therapy...
...recommends amoxicillin-clavulanate rather tha...
The IDSA recommends amoxicillin-clavulanate rather...
...A recommends “high-dose” amoxicillin-cla...
...nds a β-lactam agent (amoxicillin-cla...
...ides (clarithromycin and azithromyci...
...sulfamethoxazole (TMP/SMX) is NOT r...
...may be used as an alternative regime...
...ird generation oral cephalosporins are no...
...IDSA recommends either doxycycline (not su...
...e IDSA recommends levofloxacin for c...
...ough S. aureus (including methicillin-resist...
...Durat...
...commended duration of therapy for uncomplicated...
...ildren with ABRS, the IDSA still recommends a...
...Adjunct...
...e IDSA recommends intranasal saline irrigatio...
...nds intranasal corticosteroids as an adjunct t...
...ther topical nor oral decongestants...
...Second...
The IDSA recommends an alternative manag...
...ted patients who clinically worsen despite 7...
...ends that cultures be obtained by di...
...pically guided cultures of the middle meatus as...
...opharyngeal cultures are unreliable and are NOT re...
...ents with ABRS suspected to have suppurativ...
...ho are: Seriously ill and immunocompromis...
...e 1. The Natural History and Time Course of Fe...
...o Bacterial Eradication From the Ma...
...e 1. Conventional Criteria for the D...
...valence (Mean Percent of Positive Specimens...
Treatment
...Treatment...
Table 4. Antimicrobial Regimens for AB...
...Antimicrobial Regimens for ABRS i...
...vailable Antibacterials Generic...
...tions for Referral to a Specialist...
...Algorithm for the Management of...