ID- Sinusitis Flashcards
How do you diagnosis acute sinusitis
2 PODS symptoms with at least one being O or D (nasal obstruction or purulent drainage)
- Facial PAIN
- Nasal OBSTRUCTION
- Purulent DRAINAGE
- Loss of SMELL
What is the duration of acute sinusitis?
less than 4 weeks
What are additional uncomplicated symptoms of acute sinusitis?
- cough
- fatigue
- halitosis
- low-grade fever
- maxillary tooth discomfort
What are complicated acute sinusitis symptoms? (3) What does it stem from?
Stem from infectious sinusitis
- orbital cellulitis
- meningitis
- inflammation of frontal bone
What are red flags (urgent referral) for sinusitis?
- stiff neck
- vision changes
- body or eyes bulging
- altered mental status (confusion)
- Pain with eye movement
- Severe persistent headache
- orbital edema or erythema (red skin patches)
What is sputum colour an indication of?
Only tells us that there is inflammation in the nose
- does not differentiate between bacterial and viral
**NO SYMPTOMS DIFFERENTIATE
How to diagnose BACTERIAL sinusitis (2)
- Symptoms last 7-10+ days WITHOUT improvement
- twice sickening (due to secondary infection)
How to diagnose VIRAL sinusitis?
Improvement between 7-10 days
Why do we use antibiotics for acute sinusitis? what are false reasons?
CURE INFECTION
- 80% of bacterial still resolve within 14 days without therapy
Does not reduce spread
Does not reduce symptomatology
Does not reduce risk of complications
When would you give the following treatment options
1. watchful waiting
2. 72-hr trial of INCS
3. Consider antimicrobial therapy
- watchful waiting
- less than 7-10 days of symptoms - 72-hr trial of INCS
- if symptoms are uncomfortable - Consider antimicrobial therapy
- 10+ days with no clinical improvement after watchful waiting
What signs and symptoms would you use adjunct therapies ONLY
(already have non-improving/worsening symptoms or twice infection)
Mild
- slight discomfort with a minor impact on patient’s functional status
What signs and symptoms would you use adjunct therapies before considering antibiotics or close observation?
(already have non-improving/worsening symptoms or twice infection)
Moderate
- Discomfort and constant tolerable symptoms with moderate impact on patient’s functional status
What signs and symptoms would you consider using antibiotics?
(already have non-improving/worsening symptoms or twice infection)
Severe
- Major impact on the patient’s functional status and sleep
What type of therapy is used for sinusitis
Empiric therapy
What are the common bugs for sinusitis (3)
S. pneumoniae
H. influenzae
M. Catarrhalis
How much resistant/risk factors are in each bug?
H. influenzae: 50% produce beta-lactamase
M. Catarrhalis: 100% produce beta-lactamase
- give amoxi-clav
S. pneumoniae risk factors (give high dose amox)
- less than 2yo or 65+
- Daycare attendance
- recent antimicrobial use (3mos)
How to overcome resistance to Beta-lactams due to altered PBPs (intermediate resistance)
eg. s. pneumo
overcome with higher BL doses
- high dose amoxi
How do you overcome high-level resistance?
- Levo-/moxi
- vancomycin
What is the relative potency of different beta-lactams?
Amox > cefuroxime ~ cefprozil (2nd gen)»_space; cefixime (3rd gen)»_space; cephalexin (1st gen)
What are regular and high amoxicillin children dosing for s. pneumo
Regular
- 40 mg/kg/day TID
High dose
- 90 mg/kg/day BID
What are regular and high amoxicillin adult dosing for s. pneumo
Regular
- 500mg TID
High
- 1000mg TID
What is drug is effective for S. pneumo
Amoxicillin
What are regular and high amoxi-clav children dosing for s. pneumo
Regular
- 45 mg/kg/day BID to TID
High
- 45 mg/kg/day BID to TID
+
- plain 45 mg/kg/day
What is the follow up for adults?
5-7 days
If you chose delayed prescribing, what education is essential?
- Do not start unless symptoms do not improve within 7 days
- start immediately if symptoms worsen
When is amoxi-clav appropriate
- Covers beta-lactamase producing pathogens (H. flu, M. catarrhalis)
- reasonable for patients who fail amoxi in 3 days (i.e. no improvement in 3 days)
