Antibiotics and Topical Nasal Steroid for Treatment of Acute Maxillary Sinusitis

Williamson, Ian; Rumsby, Kate; Benge, Sarah; Moore, Michael; Smith, Peter; Cross, Martine; Little, Paul

doi:10.1001/jama.298.21.2487

Cited by 140 publications

(65 citation statements)

References 32 publications

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“…Intranasal corticosteroid sprays (INCSs), due to their anti-inflammatory and possible decongestant properties, have been investigated as possible adjuvant therapies to limit transcription of proinflammatory factors, stabilize phospholipid membranes, and inhibit IgEinduced release of histamine, all with the effect of reducing mucosal swelling. 186,187 Numerous studies have reported varied efficacy of intranasal or systemic corticosteroids to reduce ARS symptom severity and duration, and Cochrane review meta-analyses have reviewed trials of both modalities to provide a assessment on the role of corticosteroids in the management of ARS.…”

Section: Vd2 Ars Management: Corticosteroidsmentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

554

888

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Background:The body of knowledge regarding rhinosinusitis (RS) continues to expand, with rapid growth in number of publications, yet substantial variability in the quality of those presentations. In an effort to both consolidate and critically appraise this information, rhinologic experts from around the world have produced the International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR:RS). Methods:Evidence-based reviews with recommendations (EBRRs) were developed for scores of topics, using previously reported methodology. Where existing evidence was insufficient for an EBRR, an evidence-based review (EBR) was produced. The sections were then synthesized and the entire manuscript was then reviewed by all authors for consensus. Results:The resulting ICAR:RS document addresses multiple topics in RS, including acute RS (ARS), chronic RS (CRS) with and without nasal polyps (CRSwNP and CRSsNP), recurrent acute RS (RARS), acute exacerbation of CRS (AE-CRS), and pediatric RS. Conclusion:As a critical review of the RS literature, ICAR:RS provides a thorough review of pathophysiology and evidence-based recommendations for medical and surgical treatment. It also demonstrates the significant gaps in our understanding of the pathophysiology and optimal management of RS. Too o en the foundation upon which these recommendations are based is comprised of lowerlevel evidence. It is our hope that this summary of the evidence in RS will point out where additional research efforts may be directed. C 2016 ARS-AAOA, LLC. Key Words:rhinosinusitis; chronic rhinosinusitis; acute rhinosinusitis; recurrent acute rhinosinusitis; evidence-based medicine; systematic review; endoscopic sinus surgery List of Abbreviations Used

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Section: Vd2 Ars Management: Corticosteroidsmentioning

confidence: 99%

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Orlandi

Kingdom

Hwang

et al. 2016

Int Forum Allergy Rhinol

554

888

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“…Nonetheless, there are several RCTs in adolescents and adults, most of which do show significant differences compared with placebo or active comparator that favor intranasal steroids in the reduction of symptoms and the patient' s global assessment of overall improvement. [80][81][82][83][84][85] Several studies in adults with acute bacterial sinusitis provide data supporting the use of intranasal steroids as either monotherapy or adjuvant therapy to antibiotics. 81,86 Only one study did not show efficacy.…”

Section: Intranasal Steroidsmentioning

confidence: 99%

“…81,86 Only one study did not show efficacy. 85 There have been 2 trials of intranasal steroids performed exclusively in children: one comparing intranasal corticosteroids versus an oral decongestant 87 and the other comparing intranasal corticosteroids with placebo. 88 These studies showed a greater rate of complete resolution 87 or greater reduction in symptoms in patients receiving the steroid preparation, although the effects were modest.…”

Section: Intranasal Steroidsmentioning

confidence: 99%

Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years

Wald,

Applegate,

Bordley

et al. 2013

Pediatrics

435

368

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OBJECTIVE: To update the American Academy of Pediatrics clinical practice guideline regarding the diagnosis and management of acute bacterial sinusitis in children and adolescents. METHODS: Analysis of the medical literature published since the last version of the guideline (2001). RESULTS: The diagnosis of acute bacterial sinusitis is made when a child with an acute upper respiratory tract infection (URI) presents with (1) persistent illness (nasal discharge [of any quality] or daytime cough or both lasting more than 10 days without improvement), (2) a worsening course (worsening or new onset of nasal discharge, daytime cough, or fever after initial improvement), or (3) severe onset (concurrent fever [temperature ≥39°C/102.2°F] and purulent nasal discharge for at least 3 consecutive days). Clinicians should not obtain imaging studies of any kind to distinguish acute bacterial sinusitis from viral URI, because they do not contribute to the diagnosis; however, a contrast-enhanced computed tomography scan of the paranasal sinuses should be obtained whenever a child is suspected of having orbital or central nervous system complications. The clinician should prescribe antibiotic therapy for acute bacterial sinusitis in children with severe onset or worsening course. The clinician should either prescribe antibiotic therapy or offer additional observation for 3 days to children with persistent illness. Amoxicillin with or without clavulanate is the first-line treatment of acute bacterial sinusitis. Clinicians should reassess initial management if there is either a caregiver report of worsening (progression of initial signs/symptoms or appearance of new signs/symptoms) or failure to improve within 72 hours of initial management. If the diagnosis of acute bacterial sinusitis is confirmed in a child with worsening symptoms or failure to improve, then clinicians may change the antibiotic therapy for the child initially managed with antibiotic or initiate antibiotic treatment of the child initially managed with observation. CONCLUSIONS: Changes in this revision include the addition of a clinical presentation designated as “worsening course,” an option to treat immediately or observe children with persistent symptoms for 3 days before treating, and a review of evidence indicating that imaging is not necessary in children with uncomplicated acute bacterial sinusitis.

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“…8,9 In another study, budesonide -which is less topically potent than FFNS or MFNSgiven once daily had no benefit over placebo for ARS. 16 The differences in efficacy between these studies, including the relative potency of once daily compared with twice daily dosing, may be due to the differences in study population and the potency of the individual intranasal corticosteroid as well as symptoms comprising a MSS. Despite the carefully selected uncomplicated ARS population that would be most likely to improve spontaneously, this study demonstrated statistically significant treatment benefit of both FFNS FFNS=fluticasone furoate nasal spray.…”

Section: Interpretation Of Findings In Relation To Previously Publishmentioning

confidence: 99%

Fluticasone furoate nasal spray reduces symptoms of uncomplicated acute rhinosinusitis: a randomised placebo-controlled study

Keith

Dymek²,

Pfaar

et al. 2012

Primary Care Respiratory Journal

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Antibiotics and Topical Nasal Steroid for Treatment of Acute Maxillary Sinusitis

Cited by 140 publications

References 32 publications

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years

Fluticasone furoate nasal spray reduces symptoms of uncomplicated acute rhinosinusitis: a randomised placebo-controlled study

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