| Background |
 |
Respiratory viruses typically cause inflammation of the nasalmucosa and maxillary sinuses. |
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Most cases of acute rhinosinusitis are due to uncomplicated viral infections.
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| Diagnosis |
|
Most rhinovirus colds last 7 to 11 days (J Clin Microbiol 1997; 35:2864; JAMA 1967; 202:158). |
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Bacterial rhinosinusitis may be present if symptoms have been present >7 days and there is localization to the maxillary sinus.
|
Signs/Symptoms of
Acute Maxillary Sinusitis
(BMJ 1995;311:233) |
| |
Present
(N=92) ) |
Absent
(N=82 |
Odds
Ratio |
Fever |
89% |
79% |
2.1 |
Unilateral
maxillary
pain |
51% |
38% |
1.9 |
Maxillary
toothache |
66% |
51% |
1.9 |
Unilateral
maxillary
sinus
tenderness |
49% |
32% |
2.5 |
|
|
Generalized facial pain or tenderness, postnasal drainage, headache, and cough do not increase the predictive value of maxillary sinus symptoms. |
|
Patients may rarely present with severe symptoms of bacterial rhinosinusitis less than 7 days duration (acute focal sinusitis). Consider immediate referral to an otolaryngologist for evaluation and drainage. |
|
Sinus radiography is not recommended for routine evaluation of acute, uncomplicated bacterial rhinosinusitis. |
| |
 |
Opacification and air-fluid level have sensitivity of ~ 73% and specificity of 80% (J Clin Epidemiol 2000;53:852). |
| |
|
Mucosal abnormalities are common in patients with viral infections (J Allergy Clin Immunol 1998;102:403). |
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| Treatment |
|
Most patients with acute bacterial rhinosinusitis improve without antibiotic treatment. |
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About 81% of antibiotic treated patients and 66% of controls are improved at 10-14 days (absolute benefit of 15%). |
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Patients with mild symptoms should not receive antibiotics, but symptomatic treatment may be helpful. |
| |
|
Topical and oral decongestants may reduce nasal symptoms. |
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Most randomized trials of symptomatic therapies have been inconclusive. |
| |
Patients with moderate or severe symptoms may benefit from antibiotics. |
| |
Use a narrow spectrum agent that covers S. pneumoniae and H. influenzae. |
| |
|
Amoxicillin remains an appropriate choice for uncomplicated infections. |
| |
|
Consider second line agent if no improvement or worsening after 72 hours. |
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TIPS TO REDUCE
ANTIBIOTIC USE |
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Tell patients that antibiotic use increases the risk of an antibiotic resistant infection. |
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Identify and validate patient concerns. |
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Recommend specific
symptomatic therapy. |
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Spend time answering questions and offer a contingency plan if symptoms worsen. |
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Provide patient education materials on antibiotic resistance. |
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REMEMBER: Effective communication is more important than an antibiotic for patient satisfaction. |
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See www.cdc.gov/
drugresistance/
community or contact your local health department for more information and patient education materials. |
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Key Reference
Cooper RJ et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: Background. Annals of Internal Medicine 2001;134(6):509-17. |
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