As the majority of rhinosinusitis cases are viral, antimicrobial therapy should be initiated after establishment of a clinical diagnosis of bacterial rhinosinusitis, and β-lactam agents are recommended for initial therapy, according to the Infectious Diseases Society of America's first rhinosinusitis guidelines published online March 20 in Clinical Infectious Diseases.
Anthony W. Chow, MD, of the University of British Columbia in Vancouver, Canada, and members of a multidisciplinary panel of the Infectious Diseases Society of America reviewed the evidence and produced guidelines for diagnosis and management of acute bacterial rhinosinusitis (ABRS).
The authors report that only 2 to 10 percent of acute rhinosinusitis is bacterial. Clinical presentation with persistent, severe, or worsening symptoms is indicative of ABRS rather than viral rhinosinusitis. Antimicrobial therapy should be initiated when the clinical diagnosis of ABRS is confirmed. A β-lactam agent is recommended rather than a respiratory fluoroquinolone for initial antimicrobial therapy. Amoxicillin-clavulanate is recommended instead of amoxicillin alone in children and adults. The recommended duration of therapy is five to seven days for adults and 10 to 14 for children.
"This guideline is intended for use by all primary care physicians involved in direct patient care, with particular applicability to patients managed in community or emergency department settings," the authors write. "Continued monitoring of the epidemiology and rigorous investigation of the efficacy and cost-benefit of empiric antimicrobial therapy for suspected ABRS are urgently needed in both children and adults."
Several authors disclosed financial ties to the pharmaceutical industry.
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