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46 Cards in this Set
- Front
- Back
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ABRS |
Acute Bacterial RhinoSinusitis |
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RhinoSinusitis |
Sinusitis |
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✔️Nose Blowing ✔️Reduced Local Immunity ✔️Viral Virulence ✔️NasoPharyngeal colonization with bacteria |
Factors that contribute to MORE bacterial invasion |
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🔘 Inflammation 🔘 Damage MucoCiliary clearance 🔘 Viral OR Allergy |
Pathophysiology of ABRS |
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🔘Acute 🔘Sub-Acute 🔘Chronic |
Classification of BRS |
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Resolves in < 4 weeks |
ABRS |
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4-12 weeks |
Sub-Acute BRS |
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=> 12 weeks |
Chronic BRS |
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=> 4 episodes PER year |
Re Current ABRS |
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🔘12% of adults 🔘BRS is OVER diagnosed, ABs OVER prescribed 🔘Viral, A > C |
Epidemiology of ABRS |
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COMMON Bacteria |
ABRS |
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PolyMicrobial: ✔️Anaerobes ✔️G (-ve) Bacilli ✔️Fungi |
CBRS |
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🔘 Allergic OR NON Allergic Rhinitis 🔘Anatomic Defects (eg, Septal Deviation) 🔘Aspirin Allergy, Nasal polyps, and asthma 🔘CF OR Ciliary DysKinesia 🔘Dental Infections OR Procedures 🔘GERD 🔘ID 🔘IntraNasal Medications OR Illicit غير شرعى drugs 🔘Mechanical Ventilation 🔘NasoGastric tubes 🔘Swimming OR Diving 🔘Tobacco Smoke Exposure 🔘Traumatic Head Injury 🔘Viral Respiratory Tract Infection OR Winter Season |
RFs for ABRS |
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In A: ✔️Nasal Congestion OR Obstruction ✔️Purulent A/P Nasal Discharge ✔️Facial Congestion ✔️Facial Pain ✔️Diminished sense of smell (HYPosmia / ANosmia) |
Clinical Presentation of ABRS |
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=> 10 days WITHOUT Clinical Improvement |
PERSISTENT ABRS |
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WORSEN within 5-10 Days |
DOUBLE Sickening/Worsening ABRS |
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✔️3-4 DAYS ✔️39 °C ✔️PURULENT Nasal Discharge |
SEVERE ABRS |
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🔘RadioGraphy 🔘PARAnasal Sinus Puncture "GOLD 💛 Standard" ✔️NOT ✔️Complicated/C 🔘NasoPharyngeal Cultures: NOT recommended |
Imaging/LAB diagnosis of ABRS |
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Orbital Cellulitis OR Abcess |
COMPLICATIONS of ABRS |
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✔️Eradicate Bacteria ✔️PREVENT Serious sequela ✔️RELIEVE Symptoms ✔️NORMALIZE Nasal Environment ✔️SELECT effective AB that MINIMIZES resistance & PREVENT CDs development |
ttt Goals of ABRS |
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✔️Worsening 7-10 DAYS ✔️PERSISTENT >10 DAYS ✔️SEVERE 🔘3-4 DAYS 🔘PURULENT Nasal Discharge 🔘=>39 °C |
WHO should IMMEDIATELY receive an AB for ABRS? |
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✔️ 7 DAYS ✔️ ADEQUATE Follow-Up |
🤔 WATCHFUL WAITING |
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✔️<2 OR >65 ✔️IC ✔️PREVIOUS AB 30 ✔️HOSPITALIZATION 5 ✔️10% PRSP ✔️Day Care ✔️SEVERE |
RFs for AB resistance |
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Anti Microbial Selection for ABRS (A) |
AB required (Worsening, Persistent OR Severe) |
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AB required (Worsening, Persistent OR Severe) |
✔️NO Risk Of Resistance ✔️RISK Of Resistance |
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NO Risk Of Resistance |
🔘Amox +/- Clav 500 mg tid OR 875 mg bid (5-7 DAYS) 🔘DoxyCycline 100 mg bid OR 200 mg qd |
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RISK Of Resistance |
Amox +/- Clav 2000 mg/bid (7-10 days) |
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🔘Amox +/- Clav 500 mg tid OR 875 mg bid (5-7 DAYS) 🔘DoxyCycline 100 mg bid OR 200 mg qd |
Amox +/- Clav 2000 mg/bid (7-10 DAYS) |
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Amox +/- Clav 2000 mg/bid (7-10 DAYS) |
🔘ClindaMycin + Cef i Xime OR CefPodOxime 🔘LevoFloxAcin 500-750 mg qd (5d) OR MoxiFloxAcin 400 mg qd |
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If PENICILLIN Allergy |
✔️NO Risk Of Resistance 🔘DoxyCycline 100mg bid 🔘ClindaMycin + Cef i Xime OR CefPodOxime 🔘LevoFloxAcin 500-750 mg qd (5d) OR MoxiFloxAcin 400 mg qd ✔️RISK Of Resistance 🔘ClindaMycin + Cef i Xime OR CefPodOxime 🔘LevoFloxAcin 500-750 mg qd (5d)OR MoxiFloxAcin 400 mg qd |
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🔘DoxyCycline 100 mg bid 🔘ClindaMycin + Cef i Xime OR CefPodOxime 🔘LevoFloxAcin 500-750 mg qd (5d) OR MoxiFloxAcin 400 mg qd OR 🔘ClindaMycin + Cef i Xime OR CefPodOxime 🔘LevoFloxAcin 500-750 mg qd (5d) OR MoxiFloxAcin 400 mg qd |
CT scan, MRI, Sinus Culture |
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AntiMicrobial selection for ABRS, C |
AB required (Worsening, Persistent OR Severe) |
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AB Required (Worsening, Persistent OR Severe) |
✔️NO Risk Of Resistance ✔️RISK Of Resistance |
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NO Risk Of Resistance |
Amox +/- Clav 45 mg /kg/Day in 2 doses |
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RISK Of Resistance |
Amox +/- Clav 90 mg /Kg/Day in 2 doses |
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Amox +/- Clav 45 mg /Kg/Day in 2 doses |
Amox +/- Clav 90 mg /Kg/Day in 2 doses |
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Amox +/- Clav 90 mg /kg/Day in 2 doses |
🔘Combination therapy with ClindaMycin + Cef i Xime OR CefPodOxime 🔘MonoTherapy with 2nd OR 3rd Gen. CephaloSporin 🔘MonoTherapy with LevoFloxAcin |
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🔘Combination therapy with ClindaMycin + Cef i Xime OR CefPodOxime 🔘MonoTherapy with 2nd OR 3rd Gen CephaloSporin 🔘MonoTherapy with LevoFloxAcin |
Duration 10-14 days |
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🔘Combination therapy with ClindaMycin + Cef i Xime OR CefPodOxime🔘MonoTherapy with 2nd OR 3rd Gen CephaloSporin 🔘MonoTherapy with LevoFloxAcin |
CT scan, MRI, Sinus Culture |
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If NON-type I |
🔘Combination therapy with ClindaMycin + Cef i Xime OR CefPodOxime🔘MonoTherapy with 2nd OR 3rd Gen. CephaloSporin 🔘MonoTherapy with LevoFloxAcin |
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Macrolide ABs (AzithroMycin/ClarithroMycin) are NOT recommended BECAUSE of H. Rates of S. pneumoniae resistance |
What is the ROLE of MacroLides? |
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🔘Is an option. 🔘250-500 mg qid for 5 days 🔘500-1000 mg bid for 5 days |
ErythroMycin |
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🔘Analgesics 🔘Oral DeCongestants 🔘IntraNasal DeCongestants 🔘AntiHistamines AVOIDED 🔘GuaiFenEsin NO EVIDENCE 🔘IntraNasal CorticoSteroid RESERVED Allergic, Chronic Sinusitis 🔘Reduce Nasal sinus mucosal Inflammation facilitate drainage 🔘IntraNasal steroids in ABRS patients agree use outweigh their cost and minor A. Es |
Adjunctive (Supportive) Therapy of ABRS |
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🔘Humidifiers 🔘Vaporizers 🔘Saline (ISOtonic OR HYPERtonic Nasal sprays OR Drops) ✔️Moisturize the Nasal canal and impair crusting of secretions along & promote Ciliary function |
NON-Pharmacologic Therapy for ABRS |
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🔘10-14 days 21 days 🔘Five-day FluoroQuinoLones CephaloSporins (CefTriAxone) A UNcomplicated 🔘Failure within 7 days re-evaluation changing therapy |
Key points to BE considered |
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🔘Reduction in Nasal Congestion, discharge, facial pain OR pressure 3-5 days 🔘Adverse Events 🔘Referral: ✔️ReCurrent/ Chronic Sinusitis ✔️Failure with 1st OR 2nd line therapy ✔️Acute Ds in IC pts |
OutCome Evaluation |
