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Urgent Care Focused Guideline Highlights
The following is a highlight of a guideline from another group reviewed by Urgent Care physicians. Our intent is to assure these highlights represent the actual intent of these articles and how they relates to the practice of urgent care medicine. These highlights are not intended to substitute for independent medical judgement nor are they intended to establish a standard of care. UCCOP recommends at minimum reading those portions of this article that relate to the scope of care you provide.
IDSA Clinical Practice Guidelines for Acute Bacterial Rhinosinustis in Children and Adults
Published March 20, 2012
Synopsis by Tracey Davidoff, MD and Lee Resnick, MD
Chow, A. W. Et al (2012). IDSA Clinical Practice Guidelines for Acute Bacterial Rhinosinustis in Children and Adults. Clinical Infectious Diseases, 54(8):e72-112. Epub 2012 March 20, 2012. Full article can be found here.
Please note that strength of recommendation, quality of evidence is listed in parenthesis for each recommendation. The rating of these guidelines follows the GRADE system. More information about GRADE can be found here.
- Indications for empiric antibiotics: Typical sinus sx’s persistent or not improving in >10 days (strong, low-moderate); Severe sx’s >3-4 days (strong, long moderate); Worsening or Double-sickening in >3-4 days (strong, low moderate)
- Antibiotics in high doses due to poor penetration into the sinuses: Amoxicillin no longer recommended due to resistance (pediatrics -strong, moderate), (adults- weak, low); Amoxicillin/Clavulanate in standard doses or in high dose (2g twice a day in adults, 90mg/kg divided twice daily in pediatrics) for patients in an area with a high rate of resistance or other predisposing high risk factors (recent use of antibiotics, hospitalization, immunosuppression, daycare) (weak, moderate); Doxycycline for penicillin allergic patients (weak, low); Trimethoprim/sulfamethoxazole (high resistance, prescribe cautiously) (strong, moderate); Cephalosporins (high resistance, prescribe cautiously) (weak, moderate); Macrolides (high resistance rate due to overprescribing, prescribe cautiously) (strong, moderate); Treatment for 7 days probably sufficient in uncomplicated cases (weak, low-moderate)
- Steroid nasal sprays (weak, moderate)
- Oral steroids
- Decongestants (pseudoephedrine if patient not allergic or contraindications) may or may not be of benefit
- Mucolytics may or may not be of benefit
- Anti-histamines only if allergic component suspected
- Saline nasal sprays/rinses, not in plastic bottles due to irritating preservatives (weak, low-moderate)
- Topical decongestants and antihistamines not recommended (strong, low-moderate)
- Follow up with primary care as needed
- Plain radiographs no longer recommended under any circumstance
- CT scan only for persistent (30-90 days), chronic (>90 days), recurrent (more than one episode separated by 10 symptom free days), or suspected complications
- Patients with complications should be evaluated in the ER or by specialist ASA
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