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...
...h “persistent” symptoms or signs compatible wi...
...“severe” symptoms or signs of h...
...“worsening” symptoms or signs characte...
...Initial Treatment...
...IDSA recommends empiric antimicrobial ther...
...DSA recommends amoxicillin-clavulanate ra...
...A recommends amoxicillin-clavulanat...
The IDSA recommends “high-dose” amoxicillin-cl...
...ecommends a β-lactam agent (amoxicillin-...
...(clarithromycin and azithromycin) a...
...m/sulfamethoxazole (TMP/SMX) is NOT reco...
...ycycline may be used as an alternati...
...third generation oral cephalosporins are no long...
...mends either doxycycline (not suitable for chi...
...IDSA recommends levofloxacin for childr...
...hough S. aureus (including methicillin-resista...
...Durat...
...ed duration of therapy for uncomplicate...
...children with ABRS, the IDSA still re...
...Adjunctive Tre...
...ecommends intranasal saline irrigations with eit...
...recommends intranasal corticosteroids as an...
...her topical nor oral decongestants and/or an...
...IDSA recommends an alternative management...
...aluated patients who clinically worsen despi...
...ends that cultures be obtained by direc...
...scopically guided cultures of the middle meat...
...aryngeal cultures are unreliable and are N...
...with ABRS suspected to have suppurative co...
...atients who are: Seriously ill...
...igure 1. The Natural History and Time Cour...
...Time to Bacterial Eradication From the Maxi...
...entional Criteria for the Diagnosis of S...
...alence (Mean Percent of Positive Specimens) of Var...
Treatment
...Treatment
...Antimicrobial Regimens for ABRS in AdultsHavin...
...crobial Regimens for ABRS in ChildrenHaving troubl...
...ailable AntibacterialsHaving trouble view...
...e 7. Indications for Referral to a SpecialistHav...
...3. Algorithm for the Management...