Acute Bacterial Rhinosinusitis: Physician Information Sheet (Adults)
Principles of appropriate antibiotic use for acute rhinosinusitis apply to the diagnosis and treatment of acute maxillary and ethmoid rhinosinusitis in otherwise healthy adults.
Sinus inflammation is often viral and usually resolves without antibiotics.
- Respiratory viruses typically cause inflammation of the nasalmucosa and maxillary sinuses.
- Most cases of acute rhinosinusitis are due to uncomplicated viral infections.
- Most rhinovirus colds last 7 to 11 days (J Clin Microbiol 1997; 35:2864; JAMA 1967; 202:158).
- 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)
|Unilateral maxillary pain||51%||38%||1.9|
- 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).
- Most patients with acute bacterial rhinosinusitis improve without antibiotic treatment.
- About 81% of antibiotic treated patients and 66% of controls are improved at 10-14 days (absolute benefit of 15%).
- Patients with mild symptoms should not receive antibiotics, but symptomatic treatment may be helpful.
- Topical and oral decongestants may reduce nasal symptoms.
- 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.
Tips to Reduce Antibiotic Use
- Tell patients that antibiotic use increases the risk of an antibiotic resistant infection.
- Identify and validate patient concerns.
- Recommend specific symptomatic therapy.
- Spend time answering questions and offer a contingency plan if symptoms worsen.
- Provide patient education materials on antibiotic resistance.
- REMEMBER: Effective communication is more important than an antibiotic for patient satisfaction.
- See www.cdc.gov/drugresistance/community or contact your local health department for more information and patient education materials.
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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