Difference between revisions of "Sinusitis"

(fixing treatment recs)
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===>10 days of symptoms===
 
===>10 days of symptoms===
''OR if pt gets better and then worse again (“double sickening”)''
+
*Suspicious for bacterial origin especially with:
*Mild bacterial sinusitis (pain is mild and temperature <38.3˚C)
+
**No clinical improvement after 10 days
**Another seven days of observation
+
**Severe symptoms or high fever and purulent nasal d/c or facial pain lasting for at least 3–4 consecutive days at the beginning of illness
*Severe bacterial sinusitis (pain is moderate-severe or temperature ≥38.3˚C)
+
**Onset with newly worsening that were initially improving (‘‘doublesickening’’)
**Consider [[amoxicillin]]
+
*Acute bacterial sinusitis<ref>Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. IDSA Guidelines. 2012; Clinical Infectious Diseases e1-e41.</ref>
**Consider [[fluoroquinolone]] or [[amoxicillin-clavulanate]] if pt has had antibiotics in past 4-6wks
+
**First line is [[amoxicillin-clavulanate]] (over [[amoxicillin]] alone)
 +
**Second line is [[fluoroquinolone]] or [[doxycycline]]
  
 
===Antibiotic Failure===
 
===Antibiotic Failure===

Revision as of 01:03, 4 September 2015

Background

  • Acute (<4 weeks)
    • Acute viral
    • Acute bacterial (0.5-2% of cases)
  • Subacute (4-12 weeks)
  • Chronic (>12 weeks)
  • Other causes
    • Fungal infections
    • Allergies

Clinical Features

  • Defined as 2 or more of the following:
    • Blockage or congestion of nose
    • Facial pain or pressure
    • Hyposmia (diminished ability to smell)
    • Anterior or posterior nasal discharge lasting <12wk
  • Additional symptoms:
    • Tooth pain
    • Fever
    • Sinus pressure while bending forward to changing head position

Differential Diagnosis

Diagnosis

  • Consider CT only for toxic patients (to rule-out complication)

Management

<10 days of symptoms

  • Symptomatic treatment b/c most likely viral
    • Analgesia
    • Mechanical irrigation with buffered, hypertonic saline
    • Topical glucocorticoids - Flonase
    • Topical decongestants (e.g. oxymetazoline for no more than 3d)
    • Antihistamines
    • Mucolytics
  • Avoid antibiotics

>10 days of symptoms

  • Suspicious for bacterial origin especially with:
    • No clinical improvement after 10 days
    • Severe symptoms or high fever and purulent nasal d/c or facial pain lasting for at least 3–4 consecutive days at the beginning of illness
    • Onset with newly worsening that were initially improving (‘‘doublesickening’’)
  • Acute bacterial sinusitis[1]

Antibiotic Failure

  • Obtain culture
  • Consider nosocomial bacterial sinusitis (e.g. after prolonged nasotracheal inbutation)
  • Consider foreign body
  • Consider fungal treatment

Complications

References

  1. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. IDSA Guidelines. 2012; Clinical Infectious Diseases e1-e41.