Principles of Appropriate Antibiotic Use for Acute Sinusitis in Adults
- Vincenza Snow, MD;
- Christel Mottur-Pilson, PhD;
- John M. Hickner, MD, MSc; and
- for the American College of Physicians–American Society of Internal Medicine*
CLINICAL PRACTICE GUIDELINE, PART 1
In this guideline, we will present the supporting evidence for and make specific recommendations on how clinicians evaluating acute sinusitis can differentiate bacterial causes from viral causes and how they can determine when the use of antibiotics is beneficial. The numbers in square brackets are cross-references to the numbered sections in the accompanying background paper, “Principles of Appropriate Antibiotic Use for Acute Rhinosinusitis in Adults: Background,” which is part 2 of this guideline (see pages 498-505).
Acute Sinusitis
The term sinusitis refers to inflammation of the mucosa of the paranasal sinuses. Because sinusitis is invariably accompanied by inflammation of the contiguous nasal mucosa, rhinosinusitis has become the preferred term. Rhinosinusitis is one of the 10 most common diagnoses in ambulatory practice and is the fifth most common diagnosis for which an antibiotic is prescribed. Primary care physicians tend to think of sinusitis as an acute bacterial infection and prescribe an antibiotic in 85% to 98% of cases. However, sinusitis is frequently caused by viral infection. It will often resolve in most patients without antibiotic treatment, even if it is bacterial in origin [1.0].
Acute rhinosinusitis is defined by symptom duration of less than 4 weeks. Acute bacterial sinusitis is usually a secondary infection resulting from sinus ostia obstruction, impaired mucus clearance mechanisms caused by an acute viral upper respiratory tract infection, or both. According to epidemiologic estimates, only 0.2% to 2% of viral upper respiratory tract infections in adults are complicated by bacterial rhinosinusitis. The gold standard for diagnosis of bacterial sinusitis is sinus puncture, and Streptococcus pneumoniae and Haemophilus influenzae are the bacteria most commonly isolated from infected maxillary sinuses. However, sinus puncture is an invasive procedure seldom performed in primary care. Because no simple and accurate office-based test for acute bacterial sinusitis exists, …
This 100-word excerpt has been provided in the absence of an abstract.
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