Sinus Infections

New Clinicial Practice Guideline for Treating Acute Sinus Infections

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The Infectious Diseases Society of America (IDSA) has released a clinical practice guideline on the management of acute bacterial rhinosinusitis in children and adults.[1] Nearly one in seven people are diagnosed with a sinus infection each year. Although sinus infections are the fifth leading reason for antibiotic prescriptions, 90% to 98% of cases are caused by viruses, which are not affected by antibiotics. Used inappropriately, antibiotics foster the development of drug-resistant superbugs.

In their evidence-based review of the topic, IDSA was able to separate the evidence from clinical trials based on bacterial and viral causes of infection—which is a different methodology from that used by other organizations who have also published guidelines on acute rhinosinusitis.

Among the recommendations:

  • Bacterial rather than viral rhinosinusitis should be diagnosed when any of the following occurs:
    • Persistent symptoms lasting at least 10 days, without improvement
    • Severe symptoms or high fever and purulent nasal discharge or facial pain for three to four days at illness onset
    • Worsening symptoms after an initial respiratory infection, lasting five to six days, have started to improve
  • Empiric therapy should be started as soon as acute bacterial rhinosinusitis is diagnosed clinically. Amoxicillin/clavulanate—rather than amoxicillin alone—is recommended for both children and adults. This recommendation was made due to increases in antibiotic resistance as well as the common use of pneumococcal vaccines, which have changed the pattern of bacteria that cause sinus infections.
  • Macrolides and trimethoprim-sulfamethoxazole are not recommended as empirical therapy, because of high resistance rates.

The IDSA rhinosinusitis guidelines contain a number of other treatment recommendations, including:

  • Shorter treatment time. Most guidelines to date have recommended 10 days to two weeks of antibiotic treatment for a bacterial infection. However, the IDSA guidelines suggest that five to seven days of antibiotics is long enough to treat a bacterial infection without encouraging resistance. The IDSA guidelines still recommend children receive antibiotic treatment for 10 days to two weeks.
  • Avoiding decongestants and antihistamines. Whether the sinus infection is bacterial or viral, decongestant and antihistamines are not helpful and may make symptoms worse. Nasal steroids can help ease symptoms in people who have sinus infections and a history of allergies.
  • Saline irrigation may help. Nasal irrigation using a sterile solution–including sprays, drops or liquid–may help relieve some symptoms. However, the guidelines note this may not be helpful in children because they are less likely to tolerate the discomfort of the therapy.
  • Pain relief. Have patients take acetaminophen for sinus pain and drink plenty of fluids.

The guideline also includes an algorithm for sinusitis management, with recommendations for treating patients who do not respond to initial empirical therapy.

 

Jill Shuman, MS, ELS
Published March 27, 2012

 

Reference

  1. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults [published online ahead of print March 20, 2012]. Clin Infect Dis. doi: 10.1093/cid/cir1043.