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WASHINGTON -- Updated guidelines released in late January by
the Sinus and Allergy Health Partnership (SAHP) highlight the importance of
accurate diagnosis and treatment of acute bacterial rhinosinusitis (ABRS),
commonly known as sinusitis. The guidelines, published in this month's issue
of Otolaryngology-Head and Neck Surgery, provide recommendations for accurate
diagnosis and treatment of sinusitis. A panel of expert physicians developed
the guidelines to ensure the appropriate diagnosis and treatment of bacterial
sinusitis in adult and pediatric patients.
There are approximately 20 million cases of sinusitis reported each year,
which cost the United States economy nearly $3.5 billion dollars annually.
Furthermore, sinusitis is the fifth most common diagnosis for which an
antibiotic is prescribed.
These new guidelines are driven by evolving trends seen in antibiotic
resistance, as well as the availability of new therapeutic options, such as
high-dose amoxicillin/clavulanate (Augmentin XR) and cefdinir
SAHP first issued treatment guidelines for sinusitis in 2000 to reduce the
prescribing of antibiotics for viral infections while helping physicians
select the most appropriate antibiotics when bacterial sinus infections are
"As antibiotic resistance continues to be a problem, treatment guidelines
should evolve as well. The updated guidelines provide the most current
information on disease management, antimicrobial susceptibility patterns and
therapeutic options," said Jack Anon, MD, lead author of the guidelines and
associate clinical professor at the University of Pittsburgh. "The guidelines
also support the ongoing efforts to educate providers and patients about the
appropriate use of antibiotics and the need to choose the right antibiotic."
The widespread use of antibiotics to treat common viral illnesses such as
colds, the flu and viral sinusitis is one of the primary causes of antibiotic
resistance. Antibiotics kill bacteria, not viruses, and therefore should not
be used for viral illnesses. However, it can be challenging to differentiate
between viral and bacterial sinusitis because the clinical features of the two
infections are quite similar.
The guidelines provide diagnostic information to assist primary care
physicians in distinguishing between viral and bacterial sinusitis. According
to the guidelines, bacterial sinusitis typically develops as a complication of
a viral upper respiratory infection (URI), such as the common cold. In
general, a diagnosis of bacterial sinusitis may be made in adults or children
with a viral URI that is no better after 10 days or worsens after five to
seven days and is accompanied by some or all of the following symptoms: nasal
drainage, nasal congestion, facial pressure/pain (especially when the pain
occurs on one side and is focused in the region of a particular sinus), post-
nasal drainage, reduced sense of smell, fever, cough, fatigue, dental pain in
the jaw and ear pressure/fullness.
When a diagnosis of bacterial sinusitis is made, selection of the most
effective antibiotic is essential in the fight against antibiotic resistance.
To aid physicians in this selection, the guidelines classify the most commonly
used antibiotics into categories of expected clinical efficacy (based on a
mathematical model) against the bacteria that most often cause ABRS --
Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis.
"These guidelines should serve as the definitive resource for physicians
treating sinusitis," said Anon. "The guidelines are crafted to help
prescribers select those antibiotics with demonstrated efficacy against
Streptococcus pneumoniae, including resistant strains."
In addition to efficacy, the guidelines state that selection of the most
appropriate antibiotic for sinusitis therapy should be based on disease
severity, the rate of disease progression and recent antibiotic exposure. The
guidelines divide sinusitis into two categories of severity-mild and moderate.
Since recent use of antibiotics increases the risk of infection due to
resistant organisms, the guidelines also divide patients according to
antibiotic exposure in the previous four to six weeks.
"It is important to be judicious about choosing the appropriate
antibiotic," stated Anon. "By choosing the appropriate antibiotic,
bacteria is eradicated and there is a decreased chance of resistance."
Source: Sinus and Allergy Health Partnership