Canadian clinical practice guidelines for acute and chronic rhinosinusitis

Abstract

This document provides healthcare practitioners with information regarding the management of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) to enable them to better meet the needs of this patient population. These guidelines describe controversies in the management of acute bacterial rhinosinusitis (ABRS) and include recommendations that take into account changes in the bacteriologic landscape. Recent guidelines in ABRS have been released by American and European groups as recently as 2007, but these are either limited in their coverage of the subject of CRS, do not follow an evidence-based strategy, or omit relevant stakeholders in guidelines development, and do not address the particulars of the Canadian healthcare environment.Advances in understanding the pathophysiology of CRS, along with the development of appropriate therapeutic strategies, have improved outcomes for patients with CRS. CRS now affects large numbers of patients globally and primary care practitioners are confronted by this disease on a daily basis. Although initially considered a chronic bacterial infection, CRS is now recognized as having multiple distinct components (eg, infection, inflammation), which have led to changes in therapeutic approaches (eg, increased use of corticosteroids). The role of bacteria in the persistence of chronic infections, and the roles of surgical and medical management are evolving. Although evidence is limited, guidance for managing patients with CRS would help practitioners less experienced in this area offer rational care. It is no longer reasonable to manage CRS as a prolonged version of ARS, but rather, specific therapeutic strategies adapted to pathogenesis must be developed and diffused.Guidelines must take into account all available evidence and incorporate these in an unbiased fashion into management recommendations based on the quality of evidence, therapeutic benefit, and risks incurred. This document is focused on readability rather than completeness, yet covers relevant information, offers summaries of areas where considerable evidence exists, and provides recommendations with an assessment of strength of the evidence base and degree of endorsement by the multidisciplinary expert group preparing the document.These guidelines have been copublished in both Allergy, Asthma & Clinical Immunology and the Journal of Otolaryngology-Head and Neck Surgery.

Prevalence of Chronic Rhino Sinusitis and It's Recurrent After Treatment Compare to Its Recurrent After Surgery at Saudi Arabia, 2016.

“…(22) our study showed that for symptoms among the majority of infected respondents were absent or mild.…”

Acute Sinusitis in Outpatient Clinical Practice: Current Guidelines for the Diagnosis and Treatment Of

“…Вероятность постановки правильного диагноза значи-тельно повышается при наличии у пациента гнойных выделений из носа, тем не менее в некоторых руковод-ствах допускается постановка диагноза ОС без наличия этого симптома [3,4,10,11]. Чрезвычайно важно при постановке диагноза дифференцировать вирусный ОС от бактериального.…”

“…Большинство иностранных руководств рекомендует выжидательную тактику, т. е. наблюдение даже у пациентов с подозрением на бактериальный ОС [3,4,10]. При этом пациенту назначается местная терапия, включающая топи-ческие кортикостероиды, растворы для ирригационной терапии, деконгенстанты.…”

Antibacterial Therapy for Acute and Chronic Diseases of the Upper Respiratory Tract in Adults

“…Антибактериальная терапия назначается, если не наступает клинического улучшения в течение 2-7 дней от начала симптоматического лечения или наблюдается Лечение вирусного ОР симптоматическое, включает жаропонижающие средства, орошение полости носа солевыми растворами, интраназальные глюкокортикостероиды и деконгестанты утяжеление течения заболевания в любые сроки на фоне назначенного лечения [12,13,15]. Препаратом первого выбора при бактериальном ОР является амоксициллин/ клавуланат.…”