SINUSITIS Flashcards
MANAGEMENT
- ALL PATIENTS: IN steroids for 10-21 days:
Budesonide 64 μg per spray, 1 spray in each nostril q 12 hr
Mometasone furoate 100 μg per spray, 1 spray in each nostril q 12 hr
Fluticasone propionate 50 μg per spray, 2 sprays in each nostril q 24 hr, or 1 spray each nostril q 12 hr
Hypertonic or isotonic nasal saline irrigation
NSAIDs
- ACUTE UNCOMPLICATED BACTERIAL SINUSITIS
Clavulin 875 mg by mouth q 12 hr for 5 to 7 days
Pediatric dosing:
Infants ≥3 months: 22.5 mg/kg/dose (maximum 875 mg per dose) by mouth every 12 hours
Children and adolescents: 45 mg/kg/dose (maximum 2,000 mg per dose) by mouth every 12 hours for 5 to 7 days
Utilize 14:1 formulation (amoxicillin 600 mg/clavulanate 42.9 mg)
Doxycycline 100 mg by mouth every 12 hours for 5 to 7 days
Pediatric dosing:
Avoid in children <8 years old.
For children ≥8 years old with a weight ≥45 kg, please refer to adult dosing.
For children ≥8 years old with a weight <45 kg:
2.2 mg/kg/dose (maximum 100 mg per dose) by mouth every 12 hours for 5 to 7 days
Regimen 2
Cefpodoxime 200 mg by mouth every 12 hours
Pediatric dosing:
For children ≥12 years old, refer to adult dosing
For infants ≥12 months and children <12 years old, 5 mg/kg/dose (maximum 200 mg per dose) by mouth every 12 hours
Clindamycin 300 mg by mouth every 6 hours
COMPLICATIONS
Venous Sinus Thrombosis
Meningitis
DOCUMENTATION
HISTORY
Ask about:
SINUSITIS:
PODS
Facial pain, pressure, or fullness
Nasal Obstruction x 7 days
Purulent or discolored nasal or postnasal discharge x 7 days
Smell disorder
> / 2 features, 1 of which must be nasal obstruction, or purulent or discolored nasal or postnasal discharge.
ACUTE UNCOMPLICATED BACTERIAL SINUSITIS
PODS+
Symptoms without improvement after 10 days
Acutely worsening symptoms after 5-7 days
Worsening symptoms and/or fever after initial improvement (“double sickening”)
Fever of 39°C or higher for ≥3 days
RED FLAGS
Severe headache
Neck pain / stiffness
High fever
vomit
AMS
Visual change
Pain with extra ocular movement
PHYSICAL
Fever
Nasal obstruction
Nasal discharge
Alterations in sense of smell
Intact cranial nerves
Pain with extraocular movement
Sinusitis without complication should not cause painful extraocular movement
