Diagnosing and Treating Acute Bacterial Rhinosinusitis: New Guidelines from the Infectious Diseases Society of America

May 18th, 2012 5:52 am ET - .

Anthony W. Chow MD, FRCPC, FACP

Author – Dr. Anthony W. Chow, MD.
University of British Columbia and Vancouver Hospital
Sinus infections cause inflammation of both the sinuses and nasal cavity. The infections can sometimes last for weeks and can be very uncomfortable. They are quite common – in fact, nearly one in seven adults are diagnosed with a sinus infection each year.
My coauthors and I developed the Infectious Diseases Society of America (IDSA)’s Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults External Web Site Icon.

to help physicians make sense of how to best diagnose and treat rhinosinusitis.
Our goals for the guideline are to inform physicians regarding the appropriate diagnosis and management of rhinosinusitis and to reduce inappropriate and unnecessary use of antibiotics. Inappropriate use can cause harm by fostering antibiotic resistance, unnecessarily exposing patients to drug side effects and adding cost.

During our extensive review of the existing evidence on the topic, we found that the vast majority of sinus infections – 90% to 98% – are caused by viruses. This means that antibiotics are not effective in treating most cases of rhinosinusitis. And yet, sinus infections are the fifth leading reason for antibiotic prescriptions nationwide.
We provide specific characteristics of the illness to help doctors distinguish bacterial from viral sinus infections, and provide guidance on which antibiotics are best for appropriate and effective treatment. If symptoms last for 10 days without improvement, or include fever of 102 degrees or higher with nasal discharge and facial pain lasting three to four days, or if symptoms seem to improve after 4 to 7 days only to worsen again, the infection is likely bacterial and should be treated with antibiotics.
The guidelines advise against the current standard of care, amoxicillin, and instead recommend using amoxicillin-clavulanate for treatment if a bacterial infection is suspected. The addition of clavulanate helps to overcome resistance by inhibiting an enzyme that breaks down the antibiotic. This recommendation is a departure from previous rhinosinusitis guidelines, but was made to address antibiotic resistance and reflect the increased use of pneumococcal vaccines, which have changed the pattern of bacteria that cause sinus infections.
Read the full-text “IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults online at http://cid.oxfordjournals.org/content/54/8/1041.full.pdf+html External Web Site Icon.

or pick up the April 15 issue of Clinical Infectious Diseases.
CDC information about sinus infections can be found at: http://www.cdc.gov/getsmart/antibiotic-use/URI/sinus-infection.html
Symptom relief tips: http://www.cdc.gov/getsmart/antibiotic-use/symptom-relief.html