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 NTU scientists build new ultrasound device using 3-D printing technology
07.12.2016 | Nanyang Technological University

nachricht How to turn white fat brown
07.12.2016 | University of Pennsylvania School of Medicine

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: Significantly more productivity in USP lasers

In recent years, lasers with ultrashort pulses (USP) down to the femtosecond range have become established on an industrial scale. They could advance some applications with the much-lauded “cold ablation” – if that meant they would then achieve more throughput. A new generation of process engineering that will address this issue in particular will be discussed at the “4th UKP Workshop – Ultrafast Laser Technology” in April 2017.

Even back in the 1990s, scientists were comparing materials processing with nanosecond, picosecond and femtosesecond pulses. The result was surprising:...

Im Focus: Shape matters when light meets atom

Mapping the interaction of a single atom with a single photon may inform design of quantum devices

Have you ever wondered how you see the world? Vision is about photons of light, which are packets of energy, interacting with the atoms or molecules in what...

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

Im Focus: MADMAX: Max Planck Institute for Physics takes up axion research

The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.

The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

NTU scientists build new ultrasound device using 3-D printing technology

07.12.2016 | Health and Medicine

The balancing act: An enzyme that links endocytosis to membrane recycling

07.12.2016 | Life Sciences

How to turn white fat brown

07.12.2016 | Health and Medicine

VideoLinks
B2B-VideoLinks
More VideoLinks >>>