Management of acute bacterial rhinosinusitis: current issues and future perspectives

Abstract

Acute bacterial rhinosinusitis (ABRS), which manifests as an inflammation of at least one of the paranasal sinuses, is a major public health issue in developed countries. Diagnosis and treatment of ABRS can pose significant challenges in clinical practice, including difficulty in differentiation between viral and bacterial infection and a lack of simple, reliable and convenient methods for definitive diagnosis. Treatment choice is also a challenge because a decision is typically made empirically; therefore, the selection of therapy should be based on knowledge of local patterns of antimicrobial resistance, spectrum of activity against the most common ABRS pathogens (including those that are resistant to penicillins and macrolides) and pharmacodynamic potency. Current guidelines for diagnosis and treatment of ABRS in various countries share some similarities but also have important differences. Criteria for making the clinical diagnosis of sinusitis vary only slightly from country to country, while recommendations of therapy reflect the local impact of bacterial resistance.

The sale of antibiotics without prescription in pharmacies in Damascus, Syria

“…Countries with the most reserved antibioticprescribing patterns have relatively lower rates of antibiotics resistance [2]. Overuse of antibiotics has often been linked with increased organism resistance [3,4]; for example, most cases of acute bacterial rhino-sinusitis (RS) are preceded by viral infection, further complicating the distinction [5]. The most common pathogens isolated from infected maxillary sinuses in adults are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis [6].…”

Management of acute rhinosinusitis in primary care: changing paradigms and the emerging role of intranasal corticosteroids

“…Most cases of acute bacterial RS are preceded by viral infection, further complicating the distinction. 14 The duration of symptoms can be an important diagnostic indicator: symptoms of less than 10 days' duration should generally be presumed to be viral acute RS, or common cold, which is normally self-limiting. Non-viral acute RS is suspected when symptoms worsen after five days, or persist for longer than 10 days.…”

Orofacial pain of ear, nose and throat origin

“…ou de terrain (allergie, diabète, déficit immunitaire, etc.) [5,18]. L'algie de la sinusite maxillaire intéresse la région infraorbitaire ; elle est unilatérale, irradiant dans les dents sous-jacentes et l'orbite.…”

“…Elle s'accentue la nuit pour s'atténuer au lever. La palpation du nerf infraorbitaire déclenche une douleur variable [5]. Dans sa forme aiguë, la douleur de la sinusite maxillaire peut être confondue avec une pathologie à point de départ dentaire (voir article de Langlais et al), alors que la sinusite chronique est en règle indolore, sauf lors des poussées de réchauffement.…”