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Updated Guidelines Provide Diagnosis and Treatment Recommendations for Bacterial Sinusitis

Guidelines Underscore Importance of Selecting the Most Effective Antibiotics for the 20 Million Infections Each Year

WASHINGTON, DC -- January 21, 2004 -- Updated guidelines released today by the Sinus and Allergy Health Partnership (SAHP) highlight the importance of accurate diagnosis and treatment of acute bacterial rhinosinusitis (ABRS), commonly known as sinusitis. The guidelines, published in this month's issue of Otolaryngology-Head and Neck Surgery, provide recommendations for accurate diagnosis and treatment of sinusitis. A panel of expert physicians developed the guidelines to ensure the appropriate diagnosis and treatment of bacterial sinusitis in adult and pediatric patients.

There are approximately 20 million cases of sinusitis reported each year, which cost the United States economy nearly $3.5 billion dollars annually. Furthermore, sinusitis is the fifth most common diagnosis for which an antibiotic is prescribed.

These new guidelines are driven by evolving trends seen in antibiotic resistance, as well as the availability of new therapeutic options, such as high-dose amoxicillin/clavulanate (Augmentin XR™) and cefdinir (Omnicef®).

SAHP first issued treatment guidelines for sinusitis in 2000 to reduce the prescribing of antibiotics for viral infections while helping physicians select the most appropriate antibiotics when bacterial sinus infections are present.

"As antibiotic resistance continues to be a problem, treatment guidelines should evolve as well. The updated guidelines provide the most current information on disease management, antimicrobial susceptibility patterns and therapeutic options," said Jack Anon, M.D., lead author of the guidelines and associate clinical professor at the University of Pittsburgh. "The guidelines also support the ongoing efforts to educate providers and patients about the appropriate use of antibiotics and the need to choose the right antibiotic."

Bacterial vs. Viral Infections
The widespread use of antibiotics to treat common viral illnesses such as colds, the flu and viral sinusitis is one of the primary causes of antibiotic resistance. Antibiotics kill bacteria, not viruses, and therefore should not be used for viral illnesses. However, it can be challenging to differentiate between viral and bacterial sinusitis because the clinical features of the two infections are quite similar.

Diagnosis
The guidelines provide diagnostic information to assist primary care physicians in distinguishing between viral and bacterial sinusitis. According to the guidelines, bacterial sinusitis typically develops as a complication of a viral upper respiratory infection (URI), such as the common cold. In general, a diagnosis of bacterial sinusitis may be made in adults or children with a viral URI that is no better after 10 days or worsens after five to seven days and is accompanied by some or all of the following symptoms: nasal drainage, nasal congestion, facial pressure/pain (especially when the pain occurs on one side and is focused in the region of a particular sinus), post-nasal drainage, reduced sense of smell, fever, cough, fatigue, dental pain in the jaw and ear pressure/fullness.

Choosing An Appropriate Antibiotic
When a diagnosis of bacterial sinusitis is made, selection of the most effective antibiotic is essential in the fight against antibiotic resistance. To aid physicians in this selection, the guidelines classify the most commonly used antibiotics into categories of expected clinical efficacy (based on a mathematical model) against the bacteria that most often cause ABRS - Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis.

"These guidelines should serve as the definitive resource for physicians treating sinusitis," said Dr. Anon. "The guidelines are crafted to help prescribers select those antibiotics with demonstrated efficacy against Streptococcus pneumoniae, including resistant strains."

Guideline Categories
In addition to efficacy, the guidelines state that selection of the most appropriate antibiotic for sinusitis therapy should be based on disease severity, the rate of disease progression and recent antibiotic exposure. The guidelines divide sinusitis into two categories of severity-mild and moderate. Since recent use of antibiotics increases the risk of infection due to resistant organisms, the guidelines also divide patients according to antibiotic exposure in the previous 4-6 weeks.

In short, the guidelines recommend the following:

Recommended Treatment Options for Adults with ABRS
Mild Disease with No Recent Antibiotic Use (Past 4-6 Weeks)
Mild Disease with Previous Antibiotic Use or Moderate Disease
· amoxicillin/clavulanate (1.75g-4g/250mg/day)
· amoxicillin (1.5g-4g/day)
· cefpodoxime proxetil
· cefuroxime axetil
· cefdinir
· high-dose amoxicillin/clavulanate (4g/250 mg/day)
· respiratory fluoroquinolones (gatifloxacin/ levofloxacin/moxifloxacin)
· ceftriaxone

"It is important to be judicious about choosing the appropriate antibiotic," stated Dr. Anon. "By choosing the appropriate antibiotic, bacteria is eradicated and there is a decreased chance of resistance."


SOURCE: Cohn & Wolfe

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