Sinusitis

Question 1

microbiology of sinusitis

Answer 1

S. pneumoniae
H. influenzae
Moraxella catarrhalis
S. pyogenes

Question 2

Bacterial sinusitis diagnosis

Answer 2

Any 1:
Presence of symptoms > 10d AND not improving
Severe symptoms at onset: purulent discharge 3-4d, fever ≥ 39ºC
Double sickening: worsening of symptoms after 5-6d of improvement

Question 3

1st line treatment for sinusitis

Answer 3

amoxicillin PO 
adults: 1g TDS 
peds 80-90mg/kg/day divided BD 
amoxicillin/clavulanate PO 
adults: 625mg TDS or 1g BD 
peds: 80-90mg/kg/day divided BD

Question 4

alternative treatment for sinusitis

Answer 4

levofloxacin PO 500mg OD
moxifloxacin
cotrimoxazole
cefuroxime PO 30mg/kg/day divided BD (?)

Question 5

duration of treatment for sinusitis

Answer 5

adults: 5-10d
peds: 10-14d

Question 6

indication for amoxicillin/clavulanate over amoxicillin for sinusitis

Answer 6

recent course of antibiotics (past 30d)
recent hospitalisation (past 30d)
failure to improve after 72h of amoxicillin

Question 7

presentation of sinusitis

Answer 7

purulent anterior/posterior nasal discharge 
nasal/facial congestion 
facial pain/pressure 
hyposmia/anosmia 
fever 
HA
ear pain, pressure, fullness 
halitosis 
dental pain 
cough
fatigue

Question 8

pathogenesis of sinusitis

Answer 8

direct contact w droplets of infected saliva or nasal secretions
preceded by viral URTI