8
Management
Table 6. Factors That Would Prompt Clinicians to Consider
Prescribing Amoxicillin-Clavulanate Instead of
Amoxicillin Alone for Initial Management of ABRS
Factor Comment
Situations in which
bacterial resistance
is likely
• Antibiotic use in the past month
• Close contact with treated individuals, health care providers,
or a health care environment
• Failure of prior antibiotic therapy
• Breakthrough infection despite prophylaxis
• Close contact with a child in a daycare facility
• Smoker or smoker in the family
• High prevalence of resistant bacteria in community
Presence of
moderate to severe
infection
• Moderate to severe symptoms of ABRS
• Protracted symptoms of ABRS
• Frontal or sphenoidal sinusitis
• History of recurrent ABRS
Presence of
comorbidity or
extremes of life
• Comorbid conditions, including diabetes and chronic cardiac,
hepatic, or renal disease
• Immunocompromised patient
• Age older than 65 years old
Table 7. Patient Instructions for Optimal Use of Topical
Nasal Steroid
a
1. Shake the bottle well.
2. Look down by bending your neck and looking toward the floor.
3. Put the nozzle just inside your nose using your right hand for the left nostril and your
left hand for the right nostril.
4. Aim toward the outer wall and squirt once or twice as directed; do not aim toward the
nasal septum (in the middle of the nose) to prevent irritation and bleeding
5. Change hands and repeat for the other side.
6. Do not sniff hard.
a
Adapted from Scadding GK et. al. Clin Exp Allerg y. 2008;38(2):260-275.
