Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Most sinus infections don't require antibiotics

21.03.2012
IDSA releases first rhinosinusitis guidelines, helps doctors distinguish between bacterial and viral cause
The vast majority of sinus infections are caused by viruses and should not be treated with antibiotics, suggest new guidelines released by the Infectious Diseases Society of America (IDSA).

Nearly one in seven people are diagnosed with a sinus infection each year. Although sinus infections are the fifth leading reason for antibiotic prescriptions, 90 to 98 percent of cases are caused by viruses, which are not affected by antibiotics. Used inappropriately, antibiotics foster the development of drug-resistant superbugs.

"There is no simple test that will easily and quickly determine whether a sinus infection is viral or bacterial, so many physicians prescribe antibiotics 'just in case,'" said Anthony W. Chow, MD, chair of the guidelines panel and professor emeritus of infectious diseases at the University of British Columbia, Vancouver. "However, if the infection turns out to be viral – as most are – the antibiotics won't help and in fact can cause harm by increasing antibiotic resistance, exposing patients to drug side effects unnecessarily and adding cost."

The guidelines – the first developed by IDSA on this topic – provide specific characteristics of the illness to help doctors distinguish between viral and bacterial sinus infections. A sinus infection, called acute rhinosinusitis, is inflammation of the nasal and sinus passages that can cause uncomfortable pressure on either side of the nose and last for weeks. Most sinus infections develop during or after a cold or other upper respiratory infection, but other factors such as allergens and environmental irritants may play a role.

The guidelines recommend treating bacterial sinus infections with amoxicillin-clavulanate versus the current standard of care, amoxicillin. The addition of clavulanate helps to overcome antibiotic resistance by inhibiting an enzyme that breaks down the antibiotic. The guidelines also recommend against using other commonly used antibiotics, including azithromycin, clarithromycin and trimethoprim-sulfamethoxazole, due to increasing drug resistance.

The recommendation to use amoxicillin-clavulanate instead of amoxicillin is a major shift from older guidelines developed by other organizations. Dr. Chow notes that this recommendation was made due to increases in antibiotic resistance as well as the common use of pneumococcal vaccines, which have changed the pattern of bacteria that cause sinus infections.

The IDSA guidelines use the new GRADE system (Grading of Recommendations Assessment, Development and Evaluation), which is designed to more clearly assess the quality of evidence and strength of recommendations. The new IDSA guidelines note that randomized controlled trials referenced in previous guidelines often don't differentiate between bacterial and viral cause of infection, and therefore may not provide the best recommendations.

"These are the first evidence-based rhinosinusitis guidelines using the GRADE system," said Thomas M. File Jr., MD, co-author of the guidelines and chair of the Infectious Disease Section at Northeast Ohio Medical University, Rootstown, Ohio. "Health care providers face difficulties when treating sinus infections, and these guidelines provide the best recommendations available. The guidelines are transparent, clearly stating the level of evidence for each recommendation and pointing out where we need more research."

The IDSA rhinosinusitis guidelines contain a number of other recommendations, including:
How to tell the difference – The guidelines note a sinus infection is likely caused by bacteria and should be treated promptly with antibiotics if:

- symptoms last for 10 days or more and are not improving (previous guidelines suggested waiting seven days); or

- symptoms are severe, including fever of 102 or higher, nasal discharge and facial pain lasting 3-4 days in a row; or

- symptoms get worse, with new fever, headache or increased nasal discharge, typically after a viral upper respiratory infection that lasted five or six days and initially seemed to improve.

Shorter treatment time – Most guidelines to date have recommended 10 days to two weeks of antibiotic treatment for a bacterial infection. However, the IDSA guidelines suggest five to seven days of antibiotics is long enough to treat a bacterial infection without encouraging resistance. The IDSA guidelines still do recommend children receive antibiotic treatment for 10 days to two weeks.

Avoid decongestants and antihistamines – Whether the sinus infection is bacterial or viral, decongestant and antihistamines are not helpful and may make symptoms worse. Nasal steroids can help ease symptoms in people who have sinus infections and a history of allergies.

Saline irrigation may help – The guidelines note nasal irrigation using a sterile solution – including sprays, drops or liquid – may help relieve some symptoms. However, the guidelines note this may not be helpful in children because they are less likely to tolerate the discomfort of the therapy.

To ease symptoms of a sinus infection, Dr. File said he recommends patients take acetaminophen for sinus pain, use saline irrigation and drink plenty of fluids.

The voluntary guidelines are not intended to take the place of a doctor's judgment, but rather support the decision-making process, which must be individualized according to each patient's circumstances.

The 11-member guidelines panel comprises rhinosinusitis experts representing a variety of organizations, including the Centers for Disease Control and Prevention (CDC), the American College of Physicians, and the Society of Academic Medicine. In addition to Drs. Chow and File, the rhinosinusitis guidelines panel includes: Michael S. Benninger, Itzhak Brook, Jan L. Brozek, Ellie J.C. Goldstein, Lauri A. Hicks, George A. Pankey, Mitchel Seleznick, Gregory Volturo, and Ellen R. Wald.

IDSA has published more than 50 treatment guidelines on various conditions and infections, ranging from HIV/AIDS to Clostridium difficile. As with other IDSA guidelines, the rhinosinusitis guidelines will be available in a format designed for iPhones and other mobile devices, and in a pocket-sized quick-reference edition. Note: For a copy of the rhinosinusitis guidelines, to be published in the April 15 issue of Clinical Infectious Diseases, please contact Ashley Mattys at (312) 558-1770 or amattys@pcipr.com. The guidelines are embargoed until 12:01 a.m. EDT on March 21, 2012.

Founded in 1979, Clinical Infectious Diseases publishes clinical articles twice monthly in a variety of areas of infectious disease, and is one of the most highly regarded journals in this specialty.

The Infectious Diseases Society of America (IDSA) is an organization of physicians, scientists, and other health care professionals dedicated to promoting health through excellence in infectious diseases research, education, patient care, prevention, and public health. The Society, which has nearly 10,000 members, was founded in 1963 and is based in Arlington, Va. For more information, see www.idsociety.org.

Ashley Mattys | EurekAlert!
Further information:
http://www.idsociety.org

More articles from Health and Medicine:

nachricht On track to heal leukaemia
18.01.2017 | Universitätsspital Bern

nachricht Penn vet research identifies new target for taming Ebola
12.01.2017 | University of Pennsylvania

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: How gut bacteria can make us ill

HZI researchers decipher infection mechanisms of Yersinia and immune responses of the host

Yersiniae cause severe intestinal infections. Studies using Yersinia pseudotuberculosis as a model organism aim to elucidate the infection mechanisms of these...

Im Focus: Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.

While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...

Im Focus: Studying fundamental particles in materials

Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales

Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...

Im Focus: Designing Architecture with Solar Building Envelopes

Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.

As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...

Im Focus: How to inflate a hardened concrete shell with a weight of 80 t

At TU Wien, an alternative for resource intensive formwork for the construction of concrete domes was developed. It is now used in a test dome for the Austrian Federal Railways Infrastructure (ÖBB Infrastruktur).

Concrete shells are efficient structures, but not very resource efficient. The formwork for the construction of concrete domes alone requires a high amount of...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

12V, 48V, high-voltage – trends in E/E automotive architecture

10.01.2017 | Event News

2nd Conference on Non-Textual Information on 10 and 11 May 2017 in Hannover

09.01.2017 | Event News

Nothing will happen without batteries making it happen!

05.01.2017 | Event News

 
Latest News

Explaining how 2-D materials break at the atomic level

18.01.2017 | Materials Sciences

Data analysis optimizes cyber-physical systems in telecommunications and building automation

18.01.2017 | Information Technology

Reducing household waste with less energy

18.01.2017 | Ecology, The Environment and Conservation

VideoLinks
B2B-VideoLinks
More VideoLinks >>>