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Washington, D.C. — Physicians welcomed a new set of guidelines, published today in the May issue of Annals of Otology, Rhinology and Laryngology, that are expected to help diagnose and treat sinusitis, a condition suffered by an estimated 30 million Americans.
Although sinusitis is fairly common, it is often difficult for physicians to diagnose and properly treat the varying forms of this upper-respiratory infection. The guidelines were developed by the Clinical Advisory Committee on Pediatric and Adult Sinusitis (CAC), a group of highly respected opinion leaders in the fields of infectious diseases, pediatrics, otolaryngology, allergy and microbiology.
"These CAC guidelines provide primary care clinicians with clear and practical information regarding the diagnosis and treatment of sinusitis," said Itzhak Brook, M.D., MSc, lead author, and Professor, Department of Pediatrics and Medicine; Georgetown University School of Medicine; Washington, DC.; and member of the CAC committee. "The guidelines that we developed are designed to help physicians overcome some of the common obstacles that make an accurate diagnosis of bacterial sinusitis difficult to make as well as to treat. When treatment is indicated, we recommend starting with amoxicillin, and if no improvement occurs, switch to a second-generation cephalosporin, such as cefprozil, cefpodoxime, cefuroxime or amoxicillin-clavulanate," he continued.
The CAC goal in developing guidelines is to reduce the inappropriate use of antibiotics, which has contributed to the steep growth in antibiotic resistance. While the guidelines are based on clinical research, they also consider such practical treatment factors as compliance and cost. The economic burden of sinusitis makes it a costly disease. Consumers spend more than $2 billion annually for over-the-counter medications to relieve the symptoms of sinusitis. While antibiotic costs represent a small portion (10 percent to 16 percent) of the total costs of sinusitis treatment, the inappropriate use of antibiotic therapy can significantly contribute to increased health care costs. Patients with recurring disease use more health care resources, which further increases costs.
Sinusitis is on the rise in the U.S., accounting for an estimated 16 million office visits per year. Bacterial sinusitis, which is usually most prevalent during the fall, winter and spring months, is an inflammation of the lining of the sinuses, caused by bacterial overgrowth in a closed cavity. A lingering cold or seasonal allergies typically precedes the development of bacterial sinusitis. Other symptoms include upper respiratory tract complaints, such as facial pain or pressure; discolored nasal discharge; persistent headache; bad breath; fatigue; dental pain; or cough. Sinusitis is usually treated empirically—that is, without obtaining a specimen for bacterial culture—because of the technical difficulty of culturing the paranasal sinuses. Untreated or inappropriately treated sinus infections can lead to chronically infected sinuses or complications such as meningitis or abscesses of the brain orbital regions.
First-line sinusitis treatment includes amoxicillin and trimethoprim-sulfamethoxazole, older and relatively inexpensive antibiotics. Second-line agents should be used when the first-line agents are not effective or slightly resistant strains of bacteria are suspected. Effective second-generation cephalosporins, such as cefprozil, cefuroxime and cefpodoxime, have excellent coverage of Streptococcus pneumoniae, one of the most common bacteria causing sinus infections. Amoxicilliclavulanate, when used in areas of high penicillin resistant S. pneumoniae, should be combined with amoxicillin, as regular dose may not be adequate to overcome resistance.
"While other guidelines have previously been developed on sinusitis, none have outlined the diagnostic and treatment path so clearly,” remarked Seth A. Reiner, MD, chief of the Otolaryngology Sections, Porter Adventist Hospital; Denver, Colorado and Littleton Adventist Hospital; Littleton, Colorado; and member of the CAC committee. “By utilizing the CAC guidelines, primary care physicians can now be more confident in diagnosing and properly treating bacterial sinusitis."
The article can be found on the Internet at
http://www.annals.com/sup182b.pdf.
The Clinical Advisory Committee on Pediatric and Adult Sinusitis was supported by an educational grant from Bristol-Myers Squibb Company.
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