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SOURCE

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Source: Frei C, Frei B. Upper respiratory tract infections. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146071422. Accessed April 13, 2017.

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CONDITION/DISORDER SYNONYMS

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  • Rhinosinusitis.

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DEFINITION

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  • Inflammation and/or infection of paranasal sinus mucosa.

    • Acute: lasts <30 days with complete resolution of symptoms.

    • Chronic: episodes of inflammation lasting >3 months with persistence of respiratory symptoms.

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ETIOLOGY

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  • Majority of cases viral.

    • Consider bacterial infection if symptoms persist for ≥10 days or become severe.

  • Bacterial causes: S. pneumoniae and H. influenza

    • Responsible for approximately 50–70% of bacterial causes of acute sinusitis in both adults and children.

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PATHOPHYSIOLOGY

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  • Acute bacterial sinusitis usually preceded by viral respiratory tract infection that causes mucosal inflammation.

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EPIDEMIOLOGY

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  • Most cases have viral etiology yet antibiotics prescribed for adults and children.

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RISK FACTORS

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  • Viral respiratory tract infection.

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CLINICAL PRESENTATION

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  • Persistent.

    • Lasting ≥10 days and without clinical improvement.

  • Severe.

    • High fever with temperature ≥39°C (102.2°F)

    • Purulent nasal discharge or facial pain lasting >3–4 days.

  • Worsening.

    • New-onset of fever, headache.

    • Increase in nasal discharge following a viral URI lasted 5–6 days and were improving.

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SIGNS AND SYMPTOMS
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  • Purulent or discolored anterior or posterior nasal discharge.

  • Nasal congestion or obstruction.

  • Facial congestion or fullness.

  • Facial pain or pressure.

  • Fever.

  • Headache.

  • Ear pain/pressure/fullness.

  • Halitosis.

  • Dental pain.

  • Cough and fatigue.

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DIAGNOSIS

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MEANS OF CONFIRMATION AND DIAGNOSIS
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  • Gold standard: Sinus puncture with recovery of bacteria in high density.

    • Not routinely performed since invasive procedure.

  • Diagnosis based on clinical findings.

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IMAGING
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  • Sinus radiography.

    • Not routinely used for uncomplicated sinusitis.

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DIAGNOSTIC PROCEDURES
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  • Sinus puncture.

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DESIRED OUTCOMES

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  • Reduce signs and symptoms.

  • Achieve and maintain patency of ostia.

  • Limit antimicrobial treatment to those who may benefit.

  • Eradicate bacterial infection with appropriate antimicrobial therapy.

  • Minimize duration of illness.

  • Prevent complications.

  • Prevent progression from acute disease to chronic disease.

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TREATMENT: GENERAL APPROACH

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  • Delineate viral and bacterial sinusitis.

    • Based on disease duration.

      • Viral: typically improves in 7–10 days.

      • Bacterial: persistent symptoms ≥10 days or worsening of symptoms after 5–6 days.

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TREATMENT: NONPHARMACOLOGIC THERAPY

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  • Irrigation of nasal cavity with saline and steam inhalation to increase mucosal moisture.

  • Mucolytics (eg, guaifenesin) to decrease viscosity of nasal secretions.

  • Nasal decongestant sprays such as phenylephrine and oxymetazoline.

    • Reduce inflammation by vasoconstriction.

    • Limit use to no more than 3 days to prevent rebound congestion.

  • Oral decongestants may also aid in nasal or sinus patency.

  • Avoid use of ...

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