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...