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
...agnosis...
...ersistent” symptoms or signs compatible...
...th “severe” symptoms or signs of high fever (...
...orsening” symptoms or signs charact...
Initial Treatment
...commends empiric antimicrobial therapy b...
The IDSA recommends amoxicillin-clavulana...
...ommends amoxicillin-clavulanate rather t...
...ommends “high-dose” amoxicillin-clavu...
...ecommends a β-lactam agent (amoxicillin-c...
...(clarithromycin and azithromycin) are NOT recomme...
...lfamethoxazole (TMP/SMX) is NOT recommended for...
Doxycycline may be used as an alternative regim...
...nd and third generation oral cephalosp...
...recommends either doxycycline (not suitable for c...
...ecommends levofloxacin for children with a...
...ureus (including methicillin-resistant S....
...uration of Treatm...
...ded duration of therapy for uncomplicated...
...th ABRS, the IDSA still recommends a longer...
...junctive Treatment...
...mmends intranasal saline irrigations with...
...nds intranasal corticosteroids as an adjunct t...
...either topical nor oral decongestants...
...ary Treatment
...he IDSA recommends an alternative management s...
...atients who clinically worsen despite 72 hours, o...
...IDSA recommends that cultures be obtain...
...nsider endoscopically guided culture...
...ultures are unreliable and are NOT recommended fo...
...tients with ABRS suspected to have suppurat...
...are: Seriously ill and immunocomprom...
.... The Natural History and Time Course of Fever an...
...2. Time to Bacterial Eradication...
...tional Criteria for the Diagnosis of Sinusit...
...Prevalence (Mean Percent of Positive Specimen...
Treatment
...atment...
...microbial Regimens for ABRS in AdultsHa...
...microbial Regimens for ABRS in ChildrenHaving t...
...Table 6. Available AntibacterialsHaving trouble...
...ndications for Referral to a SpecialistHaving...
...3. Algorithm for the Management of AB...