Friday, September 28, 2012

Acute rhinosinusitis in Russia

Acute rhinosinusitis in Russia: differences and similarities

In Russia, the pathogens most commonly involved in the development of acute bacterial rhinosinusitis are Streptococcus pneumoniae and Haemophylus influenzae, in that order.

Their distribution is similar to the rest of Europe, although with a higher prevalence of the beta-haemolytic pneumococcus (more than 15%), which is furthermore associated with more severe episodes of acute rhinosinusitis.
In West Europe, one of the biggest problems faced in the management of this disease is the growing bacterial resistance to the main antibiotics of choice, particularly in countries such as France or Spain (39% of the pneumococci are resistant to cephalosporins, 37% are resistant to macrolides, 28% are resistant to penicillins). The situation is less dramatic in East Europe, with lower resistance rates (although the trend is for resistance to increase). In fact, to date, only the pneumococcus’s resistance to two reference antibiotics is worrying: co-trimoxazole (32.4%) and tetracycline (29.4%). However; resistance to other antibiotics, such as moxifloxacin, amoxicillin or amoxicillin/clavulanic acid, is virtually non-existent. A similar situation is observed for H. influenzae, which is not very sensitive to the effect of co-trimoxazole and clarithromycin, but poses virtually no resistance problems to other antibiotics of choice.


 Another difference between the management of acute bacterial rhinosinusitis in Russia and in West European countries is that, in cases of mild disease, the Russian specialists usually do not recommend the use of systemic antibiotics, preferring to use nasal irrigations, decongestants and/or topical antibiotics.
On the other hand, no significant divergences are seen between the main reference antibiotics, with the first-choice antibiotics being amoxicillin and amoxicillin/clavulanic acid. In more severe cases (patients in whom a prior antibiotic therapy against the same episode of rhinosinusitis has failed), it is preferred to use drugs such as quinolones (third or fourth generation), macrolides or i.v. ceftriaxone.

As the speaker stressed, the Russian specialists show particular commitment to the treatment of acute rhinosinusitis. “Not only do they follow the recommendations given in national and international guidelines in a high percentage of cases but, in certain cases, they often prescribe alternative treatment methods, such as antral puncture or phytotherapy.”
Antibiotic resistance: Europe


Results with cyclamen extract 
Administration of cyclamen extract for the treatment of acute rhinosinusitis is becoming increasingly common in the Russian Federation. Russian otorhinolaryngologists have been showing a keen interest in the therapeutic properties of this product for some time and participate actively in numerous research projects that not only analyse the treatment’s clinical outcome but also seek to ascertain the pathophysiological mechanisms that enable cyclamen to be an effective treatment for this disease.
To illustrate this point, explained the design and results of a laser Doppler flowmetry study that has quantified nasal blood flow in 30 people distributed in equal numbers to three groups: healthy volunteers, patients with acute rhinosinusitis and patients with chronic rhinosinusitis. The results of this study suggest that the increased nasal blood flow over a prolonged period may play a crucial role in this product’s mechanism of action, with effects on the nasal mucous glands and secretion accumulation.

Prof. A. S. Lopatin
ENT Clinic. Sechenov Medical Academy. Moscow

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