Upper Respiratory Tract Infections - Acute Bacterial Rhinosinusitis Flashcards
What is ABRS?
Acute rhinosinusitis thought to be due to bacterial pathogen
What are persistent symptoms in ABRS?
10 or more days with no improvement
What are severe symptoms of ABRS?
-Fever
-Purulent nasal discharge
-Facial pain for 3-4 consecutive days at beginning of illness
What are worsening symptoms of ABRS?
New onset of symptoms after initial improvement in symptoms
How does ABRS develop?
-Viral upper respiratory tract infection causes inflammation
-This then decreases sinus drainage causing mucosal secretions to be trapped
-This then allows local bacteria to proliferate establishing a bacterial infection
Most common pathogens associated with ABRS
-Strep pneumoniae
-Haemophilus influenzae
-Moraxella catarrhalis
Additional pathogens in ABRS patients with frequent antibiotic use
-Staph aureus (MSSA, MRSA)
-Pseudomonas
Major symptoms of ABRS
-Purulent anterior and/or posterior nasal discharge
-Nasal congestions and obstruction
-Facial congestion and fullness
-Facial pain and pressure
-Hyposmia or anosmia (decreased or no sense of smell)
-Fever
Minor symptoms of ABRS
-Headache
-Ear pain, pressure, or fullness
-Halitosis (bad breath)
-Dental pain
-Cough
-Fatigue
What are the three criteria to diagnose acute rhinosinusitis as bacterial?
-Persistent symptoms
-Severe symptoms
-Worsening symptoms (after initial improvement)
What are the two approaches to treating ABRS?
-Initiate antibiotic therapy as soon as bacterial infection is established
-Watchful waiting up to 7 days to observe if improvement occurs without antibiotic therapy
First-line treatment options for ABRS
-Augmentin 500/125 mg PO TID or 875/125 mg PO BID
-Augmentin 2000/125 mg PO BID if concern for penicillin resistance
Second-line treatment options for ABRS
-Doxycycline 100 mg PO BID
-Levofloxacin 500 mg PO once daily
-Moxifloxacin 400 mg PO once daily
What is the duration of treatment for ABRS?
5-7 days
Why are oral second and third generation cephalosporins, macrolides, and bactrim not recommended for ABRS?
Concern for S. pneumoniae resistance
What would you treat ABRS with if you are concerned for MRSA?
-Add an agent with MRSA coverage (doxycycline, Bactrim, linezolid, clindamycin) along with Augmentin
-Maintain coverage for common organisms unless cultures suggest monomicrobial infection with MRSA
What would you treat ABRS with if you are concerned for pseudomonas?
-Levofloxacin - consider higher dose with 750 mg PO daily
-Maintain coverage for common organisms unless cultures suggest monomicrobial infection with pseudomonas
Supportive care for ABRS
-Intranasal saline irrigation
-Warm facial packs
-NSAIDs and/or acetaminophen
-Maintain hydration - thin secretions
-Avoid antihistamines - thickens mucus, more difficult to clear
-Caution with decongestants - concern for rebound congestion
