Advertisement

Protecting Older, Vulnerable Patients From the Flu

People aged 65 and older account for more than 60% of the estimated 226,000 flu-related hospitalizations and 90% of the 3,000 to 49,000 flu-related deaths in the United States each year. This age group is at highest risk for contracting influenza and developing its potentially serious complications, including pneumonia, bronchitis, sinus and ear infections, and coronary problems. Flu symptoms can even exacerbate other comorbid conditions. This puts patients at greater risk for complications and reduces quality of life. Collectively, these health issues can result in hospitalization and even death in older patients. Be Vigilant of Those at Higher Risk for Flu As the 2012-2013 influenza season continues and we look ahead to the next, it’s important to improve community-wide vaccination rates so that we can protect public health, especially when treating adults aged 65 and up. Seniors are at higher risk for influenza because the immune system weakens with age. In turn, the body’s ability to produce a sufficient amount of protective antibodies is reduced. When considering influenza vaccine resources for the season, it’s important to offer a variety of vaccine options and newer delivery systems. Merle C. Turner, DO A few years ago, the healthcare world received good news when a higher dose of the influenza vaccine was approved by the FDA for older patients. Designed for those aged 65 and older, the vaccine generates a stronger immune response because it contains four times the amount of antigen as the standard dose. While the high-dose vaccine has shown a higher risk for side effects at the injection site, there is no greater risk of a systemic reaction than...

Welcome Guidelines for Managing Rhinosinusitis

Recent estimates suggest that the direct annual costs of sinusitis are approximately $5.8 billion in the United States, and nearly one in seven Americans is diagnosed with a sinus infection every year. Rhinosinusitis is one of the most common reasons patients seek medical help. It ranks among the top five reasons for antibiotic prescriptions for adults. However, 90% to 98% of patients presenting with symptoms of sinusitis have viral causes and will not benefit from antibiotics. The overuse of antibiotics among this population has contributed largely to the emergence of antimicrobial resistance. The Need for Guidance “Clinicians need clear guidance on how to treat patients with rhinosinusitis and on how to differentiate viral from bacterial infections,” says Thomas M. File, Jr., MD. In the April 15, 2012 issue of Clinical Infectious Diseases, Dr. File coauthored guidelines from the Infectious Disease Society of America (IDSA) on acute bacterial rhinosinusitis in children and adults. “Reasonable criteria are needed for making decisions on when it’s appropriate to prescribe antibiotics in rhinosinusitis,” he says. “We also wanted to provide an update on the information available on the bacteria that are causing bacterial sinusitis as a result of emerging resistance [Table 1].” With no simple test to quickly determine whether an infection is viral or bacterial, many physicians prescribe antibiotics to play it safe. According to Dr. File, this practice has led patients to expect to receive antibiotics when they have an infection. “If they aren’t prescribed one, they may be dissatisfied with the patient–physician interaction,” he adds. “Patients and physicians both need to be educated that using antibiotics when they’re unwarranted will provide...
First-Ever Guidelines for Acute Bacterial Rhinosinusitis

First-Ever Guidelines for Acute Bacterial Rhinosinusitis

The first-ever recommendations for the diagnosis and management of acute bacterial rhinosinusitis (ABRS) infections were published by the Infectious Diseases Society of America. Posted online at the end of March, they will appear in the April 15, 2012 issue of Clinical Infectious Diseases. Rhinosinusitis is the 5th leading indication for antimicrobial prescriptions by doctors in a practice. Due to a lack of existing clinical criteria to accurately differentiate bacterial from viral acute rhinosinusitis, excessive and inappropriate antibiotic prescriptions occur. Clinicians are forced to rely on clinical presentations to distinguish bacterial from viral rhinosinusitis. The new ABRS guidelines suggest that the infection is probably bacterial if any of the following are present: Persistent symptoms or signs of acute rhinosinusitis last for 10 days or more. Severe symptoms or signs of high fever (102°F) and purulent nasal discharge or facial pain lasting for at least 3-4 consecutive days at the beginning of an illness Worsening symptoms or signs characterized by new onset of fever, headache, or increase in nasal discharge following a typical viral upper respiratory infection that lasted 5-6 days and initially improved (“double-sickening”) First-line therapy: Once a clinical diagnosis of ABRS is established, it is recommended that empiric antimicrobial therapy be initiated immediately with amoxicillin-clavulanate (rather than amoxicillin alone) for both adults and children. High-dose (2 g orally twice daily or 90 mg/kg/day orally twice daily) amoxicillin-clavulanate is recommended for children and adults with ABRS from geographic regions with high endemic rates of invasive penicillin-nonsusceptible S. pneumoniae, those with severe infection, attendance at daycare, age <2 or >65 years, recent hospitalization, antibiotic use within the past month, or who...
[ HIDE/SHOW ]