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
...ersistent” symptoms or signs compa...
...severe” symptoms or signs of high fever (...
...t with “worsening” symptoms or signs charact...
...al Treatment...
...DSA recommends empiric antimicrobia...
...e IDSA recommends amoxicillin-clavulana...
...mmends amoxicillin-clavulanate rather than amoxici...
...DSA recommends “high-dose” amoxicillin-cla...
...recommends a β-lactam agent (amoxi...
...(clarithromycin and azithromycin) are NOT recommen...
...ethoprim/sulfamethoxazole (TMP/SMX) is NOT recomm...
...line may be used as an alternative regimen to amox...
...d third generation oral cephalosporins...
...ecommends either doxycycline (not suitable...
...SA recommends levofloxacin for children with a...
...lthough S. aureus (including methicillin-resi...
...ation of Treat...
The recommended duration of therapy for unc...
...ildren with ABRS, the IDSA still recommen...
...junctive Treatment...
...IDSA recommends intranasal saline irrigations...
...he IDSA recommends intranasal corticostero...
...r topical nor oral decongestants and/...
...ary Treatment...
...IDSA recommends an alternative management strategy...
...ed patients who clinically worsen...
The IDSA recommends that cultures be...
...onsider endoscopically guided cultures o...
...yngeal cultures are unreliable and are NOT r...
...th ABRS suspected to have suppurative complicatio...
...tients who are: Seriously ill and immunocom...
...tural History and Time Course of F...
...e 2. Time to Bacterial Eradication Fr...
...onventional Criteria for the Diagnosis of...
.... Prevalence (Mean Percent of Positive Specimen...
Treatment
...atment...
...ble 4. Antimicrobial Regimens for ABRS in Adu...
...ble 5. Antimicrobial Regimens for ABRS...
...able 6. Available AntibacterialsHaving trou...
...le 7. Indications for Referral to a Specialist...
...rithm for the Management of ABRS...