Daily Bolus of LR: Sinusitis- To Treat or Not To Treat

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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

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