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| Line 64: |
Line 64: |
| <center>More common</center> | | <center>More common</center> |
| |} | | |} |
|
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| ==Basic Management==
| |
|
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| < 10 days symptomatic treatment b/c most likely viral
| |
|
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| * Analgesia
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| * Mechanical irrigation with buffered, hypertonic saline
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| * Topical glucocorticoids
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| * Topical decongestants (e.g., oxymetazoline for no more than three days)
| |
| * Antihistamines
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| * Mucolytics
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|
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| > 10 days or if pt gets better and then worse again (“double sickening”)
| |
|
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| * Mild bacterial sinusitis when pain is mild and temperature < 38.3˚C
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| ** Another seven days of observation
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| * Severe bacterial sinusitis when pain is moderate-severe or temperature ≥38.3˚C
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| ** Consider antibiotics
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| * If the patient is immunocompromised, has an underlying or complicating condition, or patient fails observation, antibiotics are indicated
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|
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| Antibiotics
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|
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| * Choice of antibiotic depends on recent antibiotic therapy (past 4-6 weeks).
| |
| ** Amoxicillin (500mg PO TID for 10 days)
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| ** TMP-SMX
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| ** Erythromycin
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| ** <span style="display: none; line-height: 0"></span>Azithromycin
| |
| ** <span style="display: none; line-height: 0"><span style="display: none; line-height: 0"><span style="display: none; line-height: 0"></span></span><span style="display: none; line-height: 0"></span><span style="display: none; line-height: 0"></span><span style="display: none; line-height: 0"></span><span style="display: none; line-height: 0"></span></span>Cefpodoxime<span style="display: none; line-height: 0"></span><span style="display: none; line-height: 0"><span style="display: none; line-height: 0"></span></span>
| |
| * <span style="display: none; line-height: 0"><span style="display: none; line-height: 0"><span style="display: none; line-height: 0"></span></span></span>Cefdinir<span style="display: none; line-height: 0"><span style="display: none; line-height: 0"></span></span>
| |
| * <span style="display: none; line-height: 0"><span style="display: none; line-height: 0"></span></span>Cefuroxime<span style="display: none; line-height: 0"><span style="display: none; line-height: 0"><span style="display: none; line-height: 0"></span></span></span>
| |
| ** <span style="display: none; line-height: 0"></span>If initial antibiotic failure occurs consider further workup (e.g. CT) and/or further tx with either amoxicillin-clavulanate or respiratory fluoroquinolone
| |
| ** Nosocomial acute bacterial rhinosinusitis can occur (e.g., after prolonged nasotracheal intubation) and often is associated with gram-negatives; remove foreign bodies and use culture-directed antibiotic therapy
| |
| ** Immunocompromised patients at risk for acute fulminant fungal rhinosinusitis==Source==DeBonis, Kaji<span style="display: none; line-height: 0"></span>,<span style="display: none; line-height: 0"></span> <span style="display: none; line-height: 0"></span><span style="display: none; line-height: 0"></span>U<span style="display: none; line-height: 0"></span>p<span style="display: none; line-height: 0"></span><span style="display: none; line-height: 0"></span>T<span style="display: none; line-height: 0"></span>o<span style="display: none; line-height: 0"></span><span style="display: none; line-height: 0"></span><span style="display: none; line-height: 0"></span><span style="display: none; line-height: 0"></span><span style="display: none; line-height: 0"></span><span style="display: none; line-height: 0"></span><span style="display: none; line-height: 0"></span>D<span style="display: none; line-height: 0"></span>a<span style="display: none; line-height: 0"></span>t<span style="display: none; line-height: 0"></span>e "Rhinosinusitis"<div id="wikiedit" style="display: none"><div id="editor-panel" class="box">=Sinusitis[/rename.php?renamepage=Sinusitis ]={| id="edit-panel" style="table-layout: fixed; width: 100%"
| |
| |-
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| |
|
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|
| == Basic Management == | | == Basic Management == |
| Line 119: |
Line 84: |
| *If the patient is immunocompromised, has an underlying or complicating condition, or patient fails observation, antibiotics are indicated | | *If the patient is immunocompromised, has an underlying or complicating condition, or patient fails observation, antibiotics are indicated |
|
| |
|
| <br/>Antibiotics
| | ===Antibiotics=== |
|
| |
|
| *Choice of antibiotic depends on recent antibiotic therapy (past 4-6 weeks). | | *Choice of antibiotic depends on recent antibiotic therapy (past 4-6 weeks). |
| Line 127: |
Line 92: |
| *Azithromycin | | *Azithromycin |
| *Cefpodoxime | | *Cefpodoxime |
|
| |
| * Cefdinir * Cefuroxime | | * Cefdinir * Cefuroxime |
| | | |
|
| |
| | |
| *If initial antibiotic failure occurs consider further workup (e.g. CT) and/or further tx with either amoxicillin-clavulanate or respiratory fluoroquinolone | | *If initial antibiotic failure occurs consider further workup (e.g. CT) and/or further tx with either amoxicillin-clavulanate or respiratory fluoroquinolone |
|
| |
|
| |
|
| |
| *Nosocomial acute bacterial rhinosinusitis can occur (e.g., after prolonged nasotracheal intubation) and often is associated with gram-negatives; remove foreign bodies and use culture-directed antibiotic therapy | | *Nosocomial acute bacterial rhinosinusitis can occur (e.g., after prolonged nasotracheal intubation) and often is associated with gram-negatives; remove foreign bodies and use culture-directed antibiotic therapy |
|
| |
|
Background
Rhinosinusitis - Inflammation of the lining of the paranasal sinuses
Acute (< 4 weeks)
- Acute viral
- Acute bacterial (0.5-2% of cases)
Subacute (4-12 weeks)
Chronic (>12 weeks)
Other causes
- Fungal infections
- Allergies
Diagonsis
|
Classic History & Physical
|
|
Feature
|
Viral
|
Bacterial
|
|
Duration (symptoms)
|
<10days
|
Usually >10 days OR worsening symptoms within 10 days after initial improvement
|
|
Color change (nasal discharge)
|
+/−
|
+++, quality usually yellow-green and thick
|
|
Maxillary dental pain
|
+++, often unilateral and associated with a particular sinus
|
|
Postnasal drip
|
More common
|
|
Fever, cough, fatigue
|
More common
|
|
Hyposmia/anosmia
|
More common
|
Basic Management
< 10 days symptomatic treatment b/c most likely viral
- Analgesia
- Mechanical irrigation with buffered, hypertonic saline
- Topical glucocorticoids
- Topical decongestants (e.g., oxymetazoline for no more than three days)
- Antihistamines
- Mucolytics
> 10 days or if pt gets better and then worse again (“double sickening”)
- Mild bacterial sinusitis when pain is mild and temperature < 38.3˚C
- Another seven days of observation
- Severe bacterial sinusitis when pain is moderate-severe or temperature ≥38.3˚C
- Consider antibiotics
- If the patient is immunocompromised, has an underlying or complicating condition, or patient fails observation, antibiotics are indicated
Antibiotics
- Choice of antibiotic depends on recent antibiotic therapy (past 4-6 weeks).
- Amoxicillin (500mg PO TID for 10 days)
- TMP-SMX
- Erythromycin
- Azithromycin
- Cefpodoxime
* Cefdinir * Cefuroxime
- If initial antibiotic failure occurs consider further workup (e.g. CT) and/or further tx with either amoxicillin-clavulanate or respiratory fluoroquinolone
- Nosocomial acute bacterial rhinosinusitis can occur (e.g., after prolonged nasotracheal intubation) and often is associated with gram-negatives; remove foreign bodies and use culture-directed antibiotic therapy
- Immunocompromised patients at risk for acute fulminant fungal rhinosinusitis
Source
DeBonis, Kaji, UpToDate "Rhinosinusitis"
