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
...agnosi...
...“persistent” symptoms or signs compati...
...with “severe” symptoms or signs...
...“worsening” symptoms or signs cha...
...tial Treatment...
...recommends empiric antimicrobial therapy be ini...
...recommends amoxicillin-clavulanate rather than amo...
...ecommends amoxicillin-clavulanate rather tha...
...ommends “high-dose” amoxicillin-c...
...e IDSA recommends a β-lactam agent (...
Macrolides (clarithromycin and azithromycin) a...
...imethoprim/sulfamethoxazole (TMP/SMX) is...
...e may be used as an alternative regimen to amox...
...d third generation oral cephalosporins...
...SA recommends either doxycycline (not...
...he IDSA recommends levofloxacin for children...
...h S. aureus (including methicillin-resistant S....
...n of Treatment...
...e recommended duration of therapy f...
...ildren with ABRS, the IDSA still recommends...
...tive Treatment...
...DSA recommends intranasal saline irrigations wi...
...commends intranasal corticosteroids as an adjunc...
...topical nor oral decongestants and...
...dary Treatment...
...IDSA recommends an alternative management stra...
...atients who clinically worsen despit...
...he IDSA recommends that cultures be obtai...
...sider endoscopically guided cultures...
...cultures are unreliable and are NOT r...
...nts with ABRS suspected to have supp...
...ents who are: Seriously ill and immunoco...
...ure 1. The Natural History and Time Course of Fe...
...2. Time to Bacterial Eradication From the Ma...
...nventional Criteria for the Diagnosis of...
...nce (Mean Percent of Positive Specimens) of Va...
Treatment
...atment
...microbial Regimens for ABRS in Adu...
...ntimicrobial Regimens for ABRS in ChildrenH...
Table 6. Available AntibacterialsHavin...
.... Indications for Referral to a Spec...
...rithm for the Management of ABRS...