The diagnosis and treatment of acute bacterial sinusitis


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The diagnosis and treatment of acute bacterial sinusitis

  1. 1. The Diagnosis and Treatment of Acute Bacterial SinusitisAt a recent symposium, Dr. Sabena Toor Hendrix of Cedars-Sinai Medical Center gave apresentation on the Clinical Overview of Acute Bacterial Sinusitis (ABS) and CommunityAcquired Pneumonia CAP). In the presentation, Dr. Hendrix discussed how better diagnosis andtreatment of acute bacterial sinusitis would benefit the patients in the long run.About Acute Bacterial SinusitisAs a physician you see a variety of patients each and every year. Determining whether aninfection is viral or bacterial will determine the proper treatment to be prescribed. When it comesto viral infections they:  Are self-limiting;  Start off as a viral infection 90% of the time;  Can affect patients at a minimum of 2-3 times a year and this result in them seeking medical treatment;  Are inciting causes for the development of sinusitis or pneumonia;  Generally will result into formal acute bacterial infection (ABS).About 20 million patients a year are diagnosed with ABS within the United States. It has beendetermined that ABS is the 5th most common reason why antibiotics are prescribed today.However, it needs to be ruled out that a patient is not presenting themselves with pharyngitis,pneumonia or otitis media.Diagnosing Acute Bacterial SinusitisDiagnosing ABS is important to prescribing the proper course of treatment. We need to discern ifthe patient is suffering from autoimmune disease, an infectious disease or an allergic component.Once it has been specified that the patient’s is suffering from an infectious disease we need to bespecific in noting if this infection is a viral UTI, an acute bacterial infection or a chronicinfection. It is wise to note that some patients may start out as a viral infection but end up with anacute bacterial infection. A patient may also go from an acute phase into a chronic phase. As aphysician, discerning between these three stages is vital to diagnosis and treatment.The three most common reasons for bacterial sinusitis and URTI include:  Strep/Pneumonia  Haemophilus Influenza  Moraxella Catarrhalis
  2. 2. This is why proper diagnosis is critical to the treatment process. When it comes to the sinuses themaxillary and ethmoidal sinuses seem to cause the most problems in patients. Patients sufferingfrom sinuses issues may present with:  Nasal Drainage  Sinus Congestion Lasting 3 to 5 Days  Extreme Frontal Pressure  Nasal Drip  EaracheWe should note that the symptoms may or may not be accompanied by fever, cough and fatigue.The fullness and pressure patients are feeling is due to the maxillary and ethmoidal sinuses beingfilled.Discerning Between Viral URI and BacterialKnowing whether a patient is suffering from viral URI or bacterial is important to prescribing theproper treatment. If a patient has not improved within 5 to 7 days then it needs to be consideredthat the patients viral infection may have turned into ABS. Diagnostic modalities will varyaccording to the processes and procedures in place at your facility but can include a physicalexamination of the ears, nose and throat, MRI imaging, CT scans, fiberoptic endoscopy, anteriorrhinoscopy and transilluminion.Patients who may have compromised immunity systems need to be monitored closely. This caninclude patients with cancer, immune disorders, HIV, lupus or renal disease.Treating Acute Bacterial SinusitisStudies have shown that over time, patients can build up a resistance to antibiotics. That is whyyou want to diagnose properly, treat with the appropriate medication and dosage and onlyprescribe the treatment for a period of time to adequately get rid of the infection and get thepatient back to baseline and functioning. Remember that we want the best course of treatment forthe patient and should always consider the medications safety profile, side effects and if it isgoing to work quickly.Today’s patients are more educated and smarter when it comes to their health. However at theend of the day prescribing the proper course of treatment for them is the most important factor.In addition we need to educate our patients on their prescribed treatments. Too often patients willstop taking a prescribed medication once they begin to feel better. This can cause the infection toflare up again. Patients will also save unused medications for a later date when “they” feel thatthey are experiencing the same symptoms and will self-medicate. This can not only be ineffective but cause the patient to build up a resistance to the antibiotic and this rendering it
  3. 3. ineffective for future use. So it is vital that the patient understand the reasons for taking theprescribed treatment for the recommended amount of time.Following these guidelines will allow us to reduce prescribing of antibiotics in viral illnesses andincrease the use of appropriate antimicrobial therapy when bacterial disease is likely.