Rhinosinusitis bacterial

List the most common bacterial pathogens that cause acute otitis media, acute bacterial rhinosinusitis, and acute pharyngitis. 

Identify clinical signs and symptoms associated with acute otitis media, bacterial rhinosinusitis, and streptococcal pharyngitis. 

Empirical antibiotic selection for acute bacterial rhinosinusitis should incorporate patient risk factors for bacterial resistance. 

Amoxicillin and amoxicillin-clavulanate are first-line antibiotics for acute bacterial rhinosinusitis. 

Sinusitis, or inflammation of the paranasal sinuses, is better described as rhinosinusitis that also involves inflammation of contiguous nasal mucosa, which occurs in virtually all cases of viral respiratory infections. Acute rhinosinusitis is characterized by symptoms that resolve completely in less than 4 weeks, whereas chronic rhinosinusitis typically persists as cough, rhi-norrhea, or nasal obstruction for more than 90 days. Acute bacterial rhinosinusitis (ABRS) refers to an acute bacterial infection of the sinuses that can occur independently or be superimposed on chronic sinusitis. The focus of this section will be on ABRS and appropriate treatment. 

FIGURE 69-3. Treatment algorithm3 for acute bacterial rhinosinusitis in patients with mild disease without recent antibiotic exposure.31 aAntibiotics are listed in order of predicted efficacy based on predicted clinical and bacteriologic efficacy rates, clinical studies, safety, and tolerability. Doses can be found in Table 69-4. 6Cephalosporins should be considered for patients with non-type I hypersensitivity to penicillins they are more likely to be effective than the alternative agents. cHigh doses (90 mg/kg per day) are recommended for most children, especially those with day-care contacts or frequent infections. 

Anon JB, Jacobs MR, Poole MD, et al. Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Otolaryngol Head Neck Surg 2004 130(1 suppl) lM5. 

Sinusitis is an inflammation and/or infection of the paranasal sinus mucosa. The term rhinosinusitis is used by some specialists, because sinusitis typically also involves the nasal mucosa. The majority of these infections are viral in origin. It is important to differentiate between viral and bacterial sinusitis to aid in optimizing treatment decisions. 

Agency for Health Care Policy and Research. Diagnosis and Treatment of Acute Bacterial Rhinosinusitis Summary—Evidence Report/ Technology Assessment, Number 9, March 1999. Rockville, MD, Agency for Health Care Policy and Research available at www.ahrq.gov/ clinic/epcsums/sinussum.htm. 

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