In the
NEWS Rethinking Sinusitis Treatment
Photo © BSIP SA / Alamy.
Watchful waiting and patient education are key.
E
very year in the United States, sinusitis (also known as rhinosinusitis) affects one in eight adults, and one in five antibiotic prescriptions is written for the treatment of si nusitis. In response to fears of antibiotic resistance and new epi demiologic research, the American Academy of Otolaryngology– Head and Neck Surgery Foun dation has issued a new clinical practice guideline (available at http://bit.ly/1asn04v) on treat ing adult sinusitis that calls for “watchful waiting” before pre scribing antibiotics, more patient education and counseling, and decision making that’s shared
16
AJN ▼ July 2015
▼
Vol. 115, No. 7
between patients and clinicians. Under the new guideline, clinicians must first determine whether a case of adult sinusitis is bacterial or vi ral, in order to decide whether antibiotics are appropriate. A table lists the important iden tifying symp toms of bacterial sinusitis, such as a failure to improve within 10 days and purulent nasal discharge. A separate patient information sheet also explains this process. During the watchful waiting period, nasal saline irrigation, intranasal steroids, analgesics, and antihistamines may offer symptomatic relief. Antifungal therapy is not recommended. If antibiotics are needed, amox icillin, with or without clavulanate, for five to 10 days is recommended as firstline therapy. Amoxicillin is inexpensive, and clinical trial re sults show it’s as effective as cost lier cephalosporins. A detailed algorithm further clarifies the
diagnosis and treatment of adult sinusitis. Clinicians should not order costly radiographs to diagnose si nusitis unless a complication such as a malignancy is suspected or the patient has symptoms such as facial swelling or cranial nerve palsies. If imaging is necessary, computed tomography should be used because plain film Xrays are inadequate for viewing sinuses. This new clinical guideline, an update of one issued in 2007, “represents a rigorous review of the current literature on the man agement of sinusitis by a multi disciplinary team,” says Maggie Kramper, a family NP with the Washington University Sinus In stitute in St. Louis, who served on the committee. The new em phasis on patient education and shared decision making “em powers patients and clinicians to reserve antibiotics for cases that get worse or don’t improve over time,” says Kramper. It also helps patients to select alternative treat ments, such as pain relievers, topi cal intranasal steroids, and nasal saline irrigation.—Carol Potera Rosenfeld RM, et al. Otolaryngol Head Neck Surg 2015;152(2 Suppl):S1S39.
ajnonline.com
NEWS Rethinking Sinusitis Treatment
Photo © BSIP SA / Alamy.
Watchful waiting and patient education are key.
E
very year in the United States, sinusitis (also known as rhinosinusitis) affects one in eight adults, and one in five antibiotic prescriptions is written for the treatment of si nusitis. In response to fears of antibiotic resistance and new epi demiologic research, the American Academy of Otolaryngology– Head and Neck Surgery Foun dation has issued a new clinical practice guideline (available at http://bit.ly/1asn04v) on treat ing adult sinusitis that calls for “watchful waiting” before pre scribing antibiotics, more patient education and counseling, and decision making that’s shared
16
AJN ▼ July 2015
▼
Vol. 115, No. 7
between patients and clinicians. Under the new guideline, clinicians must first determine whether a case of adult sinusitis is bacterial or vi ral, in order to decide whether antibiotics are appropriate. A table lists the important iden tifying symp toms of bacterial sinusitis, such as a failure to improve within 10 days and purulent nasal discharge. A separate patient information sheet also explains this process. During the watchful waiting period, nasal saline irrigation, intranasal steroids, analgesics, and antihistamines may offer symptomatic relief. Antifungal therapy is not recommended. If antibiotics are needed, amox icillin, with or without clavulanate, for five to 10 days is recommended as firstline therapy. Amoxicillin is inexpensive, and clinical trial re sults show it’s as effective as cost lier cephalosporins. A detailed algorithm further clarifies the
diagnosis and treatment of adult sinusitis. Clinicians should not order costly radiographs to diagnose si nusitis unless a complication such as a malignancy is suspected or the patient has symptoms such as facial swelling or cranial nerve palsies. If imaging is necessary, computed tomography should be used because plain film Xrays are inadequate for viewing sinuses. This new clinical guideline, an update of one issued in 2007, “represents a rigorous review of the current literature on the man agement of sinusitis by a multi disciplinary team,” says Maggie Kramper, a family NP with the Washington University Sinus In stitute in St. Louis, who served on the committee. The new em phasis on patient education and shared decision making “em powers patients and clinicians to reserve antibiotics for cases that get worse or don’t improve over time,” says Kramper. It also helps patients to select alternative treat ments, such as pain relievers, topi cal intranasal steroids, and nasal saline irrigation.—Carol Potera Rosenfeld RM, et al. Otolaryngol Head Neck Surg 2015;152(2 Suppl):S1S39.
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