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Rhinosinusitis

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Issue link: http://eguideline.guidelinecentral.com/i/71828

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Key Points ÎRhinosinusitis is an extremely common condition. > In a national health survey conducted during 2008, nearly 1 in 7 (13.4%) of all non- institutionalized adults ≥ 18 years were diagnosed with rhinosinusitis within the previous 12 months. > Incidence rates among adults are higher for women than men (~1.9-fold), and adults between 45 and 74 years are most commonly affected. ÎRhinosinusitis can be caused by various inciting factors including allergens, environmental irritants, and infection by viruses, bacteria and fungi. ÎThe prevalence of a bacterial infection during acute rhinosinusitis is estimated to be 2% to 10%, while viral causes account for 90% to 98%. ÎA recent national survey of antibiotic prescriptions for upper respiratory infection (URI) in the outpatient setting showed that antibiotics were prescribed for 81% of adults with acute rhinosinusitis, despite the fact that ~70% of patients improve spontaneously in placebo-controlled, randomized clinical trials. Thus, over-prescription of antibiotics is a major concern in the management of acute rhinosinusitis, largely due to the difficulty in differentiating acute bacterial rhinosinusitis (ABRS) from a viral URI. Diagnosis ÎThe Infectious Diseases Society of America (IDSA) recommends any one of the following clinical presentations for identifying patients with acute bacterial versus viral rhinosinusitis: > Onset with "persistent" symptoms or signs compatible with acute rhinosinusitis, lasting for ≥ 10 days without any evidence of clinical improvement (SR-LM) > Onset with "severe" symptoms or signs of high fever (≥ 39ºC or 102ºF) and purulent nasal discharge or facial pain lasting for at least 3-4 consecutive days at the beginning of illness (SR-LM) > Onset with "worsening" symptoms or signs characterized by the new onset of fever, headache or increase in nasal discharge following a typical viral URI that lasted 5-6 days and were initially improving ("double-sickening") (SR-LM) Initial Treatment ÎThe IDSA recommends empiric antimicrobial therapy be initiated as soon as the clinical diagnosis of ABRS is established as defined above (SR-M). ÎThe IDSA recommends amoxicillin-clavulanate rather than amoxicillin alone as empiric antimicrobial therapy for ABRS in children (SR-M). ÎThe IDSA recommends amoxicillin-clavulanate rather than amoxicillin alone as empiric antimicrobial therapy for ABRS in adults (WR-L).

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