Sinusitis

Question 1

Sinusitis - common pathogens

Answer 1

Strep pneumo (30-40%) gr+ cocci
H. Influenza (20-30%) gr - bacilli
Moraxella gr- cocci
(Similar to OM and pharyngitis)

strep pyogenes and viruses

Question 2

Sinusitis - clinical presentation/indicators for abx

Answer 2

Persistent >10 days without improvement
or
Severe s/s with high fever, purulent discharge, facial pain x 3-4 days
or
“double sickening” - was a viral URI, now new onset fever

Question 3

Sinusitis treatment plan

Answer 3

1. Symptomatic relief: analgesics, nasal irrigation.
2. Restore/improve sinus function. Consider decongestants.
3. Abx
4. Consider intranasal steroids (in allergic rhinitis patients)

Question 4

Why are antihistamines generally not recommended in sinusitis?

Answer 4

Dries up secretions/increases viscosity.

Question 5

If a pt with sinusitis improves after 3-5 days of antibiotics, how long do you continue therapy?

Answer 5

5-7 days if 1st line therapy or 7-10 days if 2nd line therapy

Question 6

If a pt with sinusitis worsens in 48-72 hours or does not improve after 3-5 days of antibiotics, what is your next action?

Answer 6

Broaden coverage or switch to another class

Question 7

After broadening coverage or changing classes for a patient that is not improving (sinusitis), what is your next action?

Answer 7

CT scan or MRI

Question 8

Sinusitis - DOC

Answer 8

AMX-CLA

If PCN sensitive, Doxycycline or Macrolid (Azithro or Clarithro)

Question 9

Why are macrolides not recommended as empiric therapy for bacterial sinusitis?

Answer 9

High rate of resistance for strep pneumo (30%)

Question 10

Should Intranasal steroids be started as an adjunct to abx for sinusitis?

Answer 10

Yes, if history of allergic rhinitis.

Question 11

Compare Tx of OM - Pharyngitis - Sinusitis

Answer 11

Similar
OM and pharyngitis are AMX
Sinusitis is a little more serious b/c close to brain so step it up - Augmentin