Sinusitis: Difference between revisions
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**First line is [[amoxicillin-clavulanate]] (over [[amoxicillin]] alone) | **First line is [[amoxicillin-clavulanate]] (over [[amoxicillin]] alone) | ||
**Second line is [[fluoroquinolone]] or [[doxycycline]] | **Second line is [[fluoroquinolone]] or [[doxycycline]] | ||
===IDSA Guidelines 2012<ref>Chow AW et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Disease (2012) 54:e72-112.</ref>=== | |||
*Highlights identifying factors for acute bacterial vs. viral rhinosinusitis | |||
*Treat with antibiotics if any of these: | |||
**Purulent discharge and pain on face or teeth > 10 days w/o improvement | |||
**Severe symptoms or fever > 39 plus symptoms > 3 days | |||
**"Double sickening" - sinusitis symptoms at end of initially improving URI that lasted > 5 days | |||
===Antibiotic Failure=== | ===Antibiotic Failure=== | ||
Revision as of 22:04, 19 July 2016
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
- Migraine
- Craniofacial neoplasm
- Foreign body retention
- Dental caries
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
- Dexamethasone 10 mg PO x1 dose
- Zicam
- Topical decongestants (e.g. oxymetazoline for no more than 3d)
- Antihistamines
- Mucolytics
- Avoid antibiotics
- Part of ACEP Choosing wisely
>10 days of symptoms
- Suspicious for bacterial origin especially with:
- No clinical improvement after 10 days
- Severe symptoms or high fever and purulent nasal discharge 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]
- First line is amoxicillin-clavulanate (over amoxicillin alone)
- Second line is fluoroquinolone or doxycycline
IDSA Guidelines 2012[2]
- Highlights identifying factors for acute bacterial vs. viral rhinosinusitis
- Treat with antibiotics if any of these:
- Purulent discharge and pain on face or teeth > 10 days w/o improvement
- Severe symptoms or fever > 39 plus symptoms > 3 days
- "Double sickening" - sinusitis symptoms at end of initially improving URI that lasted > 5 days
Antibiotic Failure
- Obtain culture
- Consider nosocomial bacterial sinusitis (e.g. after prolonged nasotracheal inbutation)
- Consider foreign body
- Consider fungal treatment
Disposition
- Typically outpatient
Complications
- Meningitis
- Cavernous sinus thrombosis (ethmoid/sphenoid)
- Intracranial abscess
- Orbital cellulitis (ethmoid)
- Frontal bone osteomyelitis (Pott's puffy tumor)
- Extradural or subdural empyema
See Also
References
- ↑ 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.
- ↑ Chow AW et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Disease (2012) 54:e72-112.