July 21, 2011 by dailybolusoflr
Sinusitis: To treat of Not to Treat
The following pertains to episodes of acute sinusitis
· Acute is defined as less than 4 weeks
o If symptoms are present for less than 7 days and are not worsening- viral etiology is most likely and no symptomatic treatment is indicated (pain control, decongestant)
o If symptoms are persistent after 10 days or are worsening after 7 days or worsen after initial improvement- bacterial etiology is likely. These patients can then be stratified into severe or non-severe. Non-severe patients don’t need to be treated with antibiotics unless they do not improve in the next 7 days.
§ For non-severe patients that do not improve- 1st line antibiotics are amoxicillin and bactrim
§ For severe patients, 1st line antibiotics are the same as above. If treatment fails, second line antibiotics are amoxicillin/clavulanate, azithromycin, clarithromycin and some cephalosporins.
§ Severe is:
· Patients with moderate to severe pain
· Temp > 38.3
· Old or young
· Immunosuppressed or with co-morbid disease
· No follow up
Note: These patients described above do NOT include patients with suspected systemic illness, or concern for local spread to intra-orbital or intra-cranial locations. These patients should be treated with broad spectrum antibiotics, typically a 3rd generation cephalosporin and vancomycin
Ref: Harwood Nuss