respiratory infections ACUTE RHINOSINUSITIS

Question 1

what is an acute inflammation of the mucosal lining of the nasal passage and paranasal sinuses

Answer 1

acute rhinosinusitis

Question 2

how long can acute rhinosinusitis last

Answer 2

up to 4 weeks

Question 3

what normally causes acute rhinosinusitis

Answer 3

virus

antibiotics are often prescribed unnecessarily

Question 4

what can cause acute rhinosinusitis

Answer 4

1. allergens
2. environmental irritants
3. infection (viral 90-98% of time)

Question 5

what bugs can cause acute bacterial rhinosinusitis (five total)

Answer 5

1. S. pneumonia
2. H influenza
3. S. Pyrogenes
4. S. aureus
5. M. catarrhalis

Question 6

what bugs can cause acute bacterial rhinosinusitis but be prevented with vaccinations

Answer 6

1. S. pneumonia

2. H influenza

Question 7

what are the 3 pathophysiological steps of ABRS

Answer 7

1. starts as a viral infection
2. inflammation causes obstruction
3. mucosal secretions become trapped and infection proliferates

Question 8

what is the greatest barrier to efficient use of antibiotics in ABRS?

Answer 8

lack of simple diagnostic test

Question 9

what is the gold standard for ABRS diagnosis

Answer 9

sinus puncture (very costly invasive and painful)

Question 10

what are the 3 clinical presentations of ABRS

Answer 10

1. onset with persistant symptoms for longer than 10 days
2. onset with severe symptoms w/ fever of 102 or greater
3. facial pain lasting 3 or 4 consecutive days
4. “double sickening”- symptoms get better for a bit then much worse

Question 11

what are the risk factors for antibiotic resistance for treating ABRS (five of them)

Answer 11

1. age less than 2 or older than 65
2. prior antibiotics that month
3. prior hospitalization in past 5 days
4. comorbidities (diabetes…)
5. immunocompromised

Question 12

what is the first line therapy for ABRS

Answer 12

amoxicillin clavulanate

Question 13

if someone has risk factors for antibiotic resistance, what should be used for ABRS

Answer 13

amoxicillin clavulanate
or
doxycycline

Question 14

If a patient has a B-lactam allergy, what should be used to treat ABRS

Answer 14

doxycycline
levofloxacin
moxifloxacin

Question 15

why is ciprofloxacin not used for ABRS

Answer 15

decreased spectrum against strep., a common bug in ABRS

Question 16

if someone has a severe ABRS infection requiring hospitalization, what treatment should be used

Answer 16

levofloxacin PO or IV
moxifloxacin PO or IV
ceftriaxone IV
cefotaxime IV

Question 17

what are 3 treatment considerations for ABRS treatment

Answer 17

1. decongestants and antihistamines can worsen infection (do not recommend)
2. intranasal saline irrigations may not work but may be recommended (won’t hurt)
3. intranasal corticosteroids are recommended for patients with a history of allergic rhinitis