Term
|
Definition
| Symptoms resolve completely in <4 weeks |
|
|
Term
|
Definition
| Symptoms resolve completely in ≥4 weeks and <12 weeks |
|
|
Term
|
Definition
≥4 episodes in one year separated by asymptomatic
periods of ≥10 days between episodes; Individual
episodes respond briskly to antibiotic therapy |
|
|
Term
|
Definition
| Signs and symptoms last for more than 12 weeks; |
|
|
Term
Acute exacerbation
of chronic
rhinosinusitis |
|
Definition
Acute exacerbation of chronic rhinosinusitis —signs and
symptoms of chronic rhinosinusitis worsen, but return to
baseline after treatment. |
|
|
Term
What percentage of acute rhinosinusitis
infections have a viral origin? |
|
Definition
|
|
Term
|
Definition
History of present illness
Nonspecific symptoms
Physical examination |
|
|
Term
|
Definition
SEVERE
symptoms (high fever ≥102°F and purulent nasal discharge for ≥3 days early in illness)
WORSENING
symptoms of URI improving initially
then suddenly worsen after 5-6 days
“double sickening”
PERSISTANT
symptoms lasting >10 days and were not improving |
|
|
Term
| Impact of improper diagnosis |
|
Definition
• Mild-to-serious adverse drug reactions
• Bacterial super-infections
• Promotion of bacterial resistance
• Increase in direct patient costs
• Increased overall health care costs
▫ >$3 billion in overall health care
expenditures in the US
every year |
|
|
Term
| Complications of sinusitis |
|
Definition
Orbital/periorbital cellulitis
• Meningitis
• Epidural/subdural/brain abscess
• Osteomyelitis of the frontal bone
with subperiosteal abscess (Pott’s
puffy tumor) |
|
|
Term
| Resistance Streptococcus pneumoniae |
|
Definition
Mechanism of Resistance
Penicillin binding protein 3 (PBP3) mutation
Treatment
Low level resistance - Increase dose
High level resistance - Avoid agent |
|
|
Term
| Resistance Haemophilus influenzae |
|
Definition
Mechanism of Resistance
β-lactamase
Treatment
Add β-lactamase inhibitor |
|
|
Term
| Resistance Moraxella catarrhalis |
|
Definition
Mechanism of Resistance
β-lactamase
Treatment
Add β-lactamase inhibitor |
|
|
Term
| The addition of the β-lactamase inhibitor clavulanic acid to amoxicillin found in Augmentin® provides an increased spectrum of action and restored efficacy against PNS(penicillin non-susceptible) S. pneumoniae. |
|
Definition
|
|
Term
| Indications for HD amoxicillin-clavulaunate (Augmentin®) |
|
Definition
Failed first-line antimicrobial regimen
Geographic regions with high endemic rates (≥10%) of invasive PNS S.
pneumoniae
Severe infection (evidence of systemic toxicity with fever ≥102°F and threat of
suppurative complications – orbital cellulitis, intracranial infection)
Attendance at daycare
Age <2 or >65 years of age
Recent hospitalization
Antibiotic use within the past month
Immunocompromised patients |
|
|
Term
| Respiratory fluoroquinolones |
|
Definition
Highly active against all common respiratory pathogens
• PNS S. pneumoniae
• β-lactamase-producing H. influenzae
• M. catarrhalis
• Ciprofloxacin lacks adequate S. pneumoniae coverage to
be considered a respiratory fluoroquinolone
Eight randomized-controlled trials (meta-analysis)
confirmed no benefit of newer respiratory
fluoroquinolones to β-lactams in clinical outcomes in
treating bacterial sinusitis |
|
|
Term
| Adverse events of fluoroquinolones |
|
Definition
CNS events (Seizures, headaches, dizziness, sleep disorders)
Peripheral neuropathy
Photosensitivity with skin rash
Disorders of glucose homeostasis (Hypoglycemia, hyperglycemia)
QT prolongation
Hepatic dysfunction
Skeleto-muscular complaints (Achilles tendon rupture: 15-20 per
100,000 in adults; Achilles tendon rupture rare in children) |
|
|
Term
| Respiratory fluoroquinolones |
|
Definition
Failed 1st-line agents
▫ History of allergic type-1 hypersensitivity to penicillin
▫ 2nd line therapy for patients at risk for PNS S. pneumoniae |
|
|
Term
|
Definition
Highly active against all recent respiratory pathogens
Favorable PK/PD properties (similar to fluoroquinolones)
• High-level cross resistance in one Swedish study:
– Resistance was 24% among PNS S. pneumoniae vs 2% in
penicillin-susceptible isolates
• SE: Gastrointestinal, photosensitivity
• Avoid in children ≤8 years old
▫ Accumulates in calcium-rich tissue
during dental development |
|
|
Term
|
Definition
• High likelihood for macrolide resistance in
▫ Prior antibiotic use (macrolides, β-lactams, TMP/SMX)
• Excellent PK/PD properties
• No longer recommended for empiric antimicrobial therapy of
S. pneumoniae infections |
|
|
Term
| Trimethoprim-sulfamethoxazole(TMP/SMX) |
|
Definition
2005-2007 data reveal high rates of resistance among both S. pneumoniae and H. influenzae
High likelihood for TMP/SMX resistance in
▫ Prior antibiotic use (TMP/SMX, macrolides, penicillin)
▫ Macrolide- or penicillin-resistant S. pneumoniae
– >80% higher resistance
• No longer recommended for empiric antimicrobial
treatment of acute bacterial rhinosinusitis |
|
|
Term
| Outpatient treatment (adults)1st-line empiric coverage |
|
Definition
Amoxicillin-clavulanate (Augmentin®) 500mg/125mg PO tid or
875mg/125mg PO bid |
|
|
Term
| Outpatient treatment(adults) β-lactam allergy |
|
Definition
Doxycycline (Vibramycin®) 100 mg PO bid or 200 mg PO daily
(can also be used 2nd-line empiric therapy)
▫ Levofloxacin (Levaquin®) 500 mg PO daily
▫ Moxifloxacin (Avelox®) 400 mg PO daily |
|
|
Term
| Outpatient treatment(adults) Risk for antibiotic resistance or failed initial therapy |
|
Definition
Amoxicillin-clavulanate (Augmentin®) 2000mg/125 mg PO bid
▫ Levofloxacin (Levaquin®) 500 mg PO daily
▫ Moxifloxacin (Avelox®) 400 mg PO daily |
|
|
Term
| Inpatient treatment (adults)Severe infection requiring hospitalization |
|
Definition
Ampicillin-sulbactam (Unasyn®) 1.5-3 g IV q6hr
▫ Levofloxacin (Levaquin®) 500 mg PO or IV daily
▫ Moxifloxacin (Avelox®) 400 mg PO or IV daily
▫ Ceftriaxone (Rocephin®) 1-2 g IV q12-24 h
▫ Cefotaxime (Claforan®) 2g IV q4-6h |
|
|
Term
| Outpatient treatment (children)Empiric coverage |
|
Definition
| Amoxicillin-clavulanate (Augmentin®) 45 mg/kg/day PO bid |
|
|
Term
| Outpatient treatment (children)B-lactam allergy |
|
Definition
Type 1 hypersensitivity
– Levofloxacin (Levaquin®) 10-20 mg/kg/day PO q12 -24 h
▫ Non-type 1 hypersensitivity
– Clindamycin (Cleocin®) 30-40 mg/kg/day PO tid plus
cefpodoxime (Vantin®) 10 mg/kg/day PO bid or cefixime
(Suprax®) 8 mg/kg/day PO bid |
|
|
Term
Outpatient treatment (children)Risk for antibiotic resistance or failed initial
therapy |
|
Definition
▫ Amoxicillin-clavulanate (Augmentin®) 90mg/kg/day PO bid
▫ Clindamycin (Cleocin®) 30-40 mg/kg/day PO tid plus
cefpodoxime (Vantin®) 10 mg/kg/day PO bid or cefixime
(Suprax®) 8 mg/kg/day PO bid
▫ Levofloxacin (Levaquin®) 10-20 mg/kg/day PO q12 -24h |
|
|
Term
| Inpatient treatment (children)Severe infection requiring hospitalization |
|
Definition
▫ Ampicillin/sulbactam (Unasyn®) 200-400 mg/kg/day IV q6h
▫ Ceftriaxone (Rocephin®) 50 mg/kg/day IV q12 h
▫ Cefotaxime (Claforan®) 100-200 mg/kg/day IV q6h
▫ Levofloxacin (Levaquin®) 10-20 mg/kg/day IV q12-24h |
|
|
Term
|
Definition
Adults:
▫ Uncomplicated bacterial rhinosinusitis:
– 5-7 days
Children:
▫ 10-14 days |
|
|
Term
|
Definition
• Intranasal saline irrigation
▫ Provides symptom relief in kids and adults
▫ Can cause nasal burning, irritation, nausea with irrigation
▫ Less tolerated in babies and young children
• Intranasal corticosteroids (INCS)
adjunctively with antibiotics
▫ Reduces mucosal swelling and promotes drainage
▫ Especially useful if history of allergic rhinitis
▫ Minimal short-term adverse events
• Focus on hydration, analgesics,
antipyretics, saline irrigation, INCS
• Topical/oral decongestants,
antihistamines, or mucolytics are not
recommended (IDSA 2012; AAP 2013)
▫ May provide symptomatic relief in acute viral
rhinosinusitis
– Subjective improvements in nasal airway patency
▫ Topical decongestants may itself induce
inflammation in the nasal cavity
▫ Antihistamines dry secretions and impair sinus
drainage (may be useful in those with allergic
rhinosinusitis) |
|
|
Term
|
Definition
• Pharmacists are poised to play a significant role
in the management of rhinosinusitis
▫ Proper recognition of cardinal symptoms and
clinical manifestations
▫ Patient education
▫ Adjunctive treatment
▫ Evidence-based
pharmacotherapy |
|
|
