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
...gnosis...
...with “persistent” symptoms or s...
...severe” symptoms or signs of high fev...
...worsening” symptoms or signs charac...
...nitial Treatment...
...IDSA recommends empiric antimicrobial...
...IDSA recommends amoxicillin-clavulanate rather...
...mends amoxicillin-clavulanate rather th...
...recommends “high-dose” amoxicillin-clavulanat...
...recommends a β-lactam agent (amoxicill...
...(clarithromycin and azithromycin)...
...thoprim/sulfamethoxazole (TMP/SMX) i...
...ne may be used as an alternative regimen...
...cond and third generation oral cephalosporins ar...
...he IDSA recommends either doxycycline (not suitabl...
...nds levofloxacin for children with a history o...
.... aureus (including methicillin-re...
...ration of Treatment...
...e recommended duration of therapy fo...
...n with ABRS, the IDSA still recommen...
...tive Treatment...
...mmends intranasal saline irrigations with eithe...
...recommends intranasal corticosteroi...
...r topical nor oral decongestants and/...
Secondary Treatmen...
...IDSA recommends an alternative management str...
...ated patients who clinically worsen de...
...ecommends that cultures be obtained by di...
...der endoscopically guided cultures of t...
...ngeal cultures are unreliable and are NOT r...
...h ABRS suspected to have suppurative comp...
...ients who are: Seriously ill and immunocompro...
...e Natural History and Time Course of Feve...
...e 2. Time to Bacterial Eradication F...
...ional Criteria for the Diagnosis of Sinusitis...
...alence (Mean Percent of Positive Specim...
Treatment
...eatment
...Antimicrobial Regimens for ABRS in AdultsH...
...ble 5. Antimicrobial Regimens for ABRS in Chi...
...Table 6. Available AntibacterialsHaving trouble...
...ble 7. Indications for Referral to a S...
...ithm for the Management of ABRS...