rhinosinusitis%20-%20acute,%20bacterial
RHINOSINUSITIS - ACUTE, BACTERIAL
Acute bacterial rhinosinusitis is the mucosal inflammation of the nose and paranasal sinuses caused by bacteria lasting ≥10 days for up to 4 weeks with no clinical improvement, severe signs or symptoms [eg high fever (39°C), purulent nasal discharge, facial pain] of ≥3-4 consecutive days, and worsening of symptoms within 10 days after initial improvement.
It is often preceded by a viral upper respiratory tract infection, rhinitis or other conditions that impair local or systemic immune function (eg nonallergic rhinitis, dental infection, mechanical obstruction of the nose, cystic fibrosis, ciliary dysfunction, immunodeficiency that impair the sinus drainage).
Signs and symptoms are nonspecific and typically difficult to differentiate from viral upper respiratory tract infection.
There is fever with nasal obstruction/congestion or anterior and/or posterior purulent drainage, with or without facial pressure/pain/fullness and reduction/loss of smell.
Streptococcus pneumoniae and unencapsulated strains of Haemophilus influenzae cause half of acute rhinosinusitis cases.

Rhinosinusitis%20-%20acute,%20bacterial Patient Education

Otolaryngologist Referral

  • Reassure and educate the patient about the nature of URTI, acute viral rhinosinusitis (AVRS), acute post-viral rhinosinusitis (APVRS) and ABRS and expected duration of illness
  • Encourage the patient to implement home self-care measures to provide relief of symptoms and prevent the occurrence of ABRS
  • Maintain adequate hydration by drinking 6-10 glasses of water/day to thin the mucus
  • Steamy baths: Inhaled steam (from a hot bath/shower) may loosen secretions
  • If necessary, increase humidity at home
  • Apply warm facial packs (eg warm wash cloth, hot water bottle) for 5-10 minutes ≥3 x/day to promote drainage of mucus and provide some localized relief
  • Adequate rest
  • Avoid irritants that affect sinuses eg cigarette smoke, extreme cool or dry air, pollution, swimming in contaminated water and barotrauma
  • Appropriate management of allergies and viral URTI
    • Hygienic measures such as frequent handwashing to prevent spread of respiratory viruses
  • There is little evidence on the efficacy of phytomedical preparations, immunomodulators and bacterial lysate preparations
  • There is no proven benefit to the use of mist, zinc salt lozenges, ascorbic acid, or echinacea
Treatment with Antibiotics
  • Educate the patient about worsening signs and symptoms that should prompt them to contact a physician 
  • It is important to counsel the patient on the use of the medications and its dosing schedule and the potential adverse effects
  • It is important to instruct the patient to complete the course of antibiotics
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