Tuesday, November 6, 2012

treatment guidelines

ABRS treatment guidelines by SAHP

In 2004, Sinus and Allergy Health Partnership (SAHP) revised treatment guidelines for acute bacterial rhinosinusitis (ABRS) to ensure that medical practitioners can easily differentiate between bacterial and viral sinusitis. Separate guidelines were issued for adults and children. This article focuses on adult guidelines.
To make selection of the empiric antibiotic therapy for adult patients with mild to moderate level symptoms of acute bacterial rhinosinusitissimple, the patients are divided into two groups based on severity of symptoms and previous therapy.


 Group1 includes patients with mild symptoms who were not administered antibiotics within last 28-42 days.
Group 2 consists of adult patients with moderate symptoms irrespective of previous antibiotic treatment, and the patients with mild symptoms who were administered antibiotics within last 28-42 days.
Guidelines for Group 1
SAHP recommends amoxicillin / clavulanate, amoxicillin, cefpooxime proxetil, cefuroxime axetil, cefdinir, β-lactam allergic# TMP/SMX (trimethoprim / sulfamethoxazole), doxycycline, azithromycin, clarithromycin, erythromycin and telithromycin for the Group 1 patients. Calculated bacteriologic and clinical efficacies of amoxicillin / clavulanate is the highest at 97-99% and 90-91% respectively. The corresponding efficacies of telithromycin are 73% and 77%. The guidelines also suggest alternatives in case the therapy does not show desired results or worsens the symptoms during 72 hours. For instance, if amoxicillin or doxycycline therapy fails, switch to gatifloxacin, levofloxacin and moxifloxacin. If cefuroxime axetil does not improve the symptoms, switch to ceftriaxone.
Combination therapy is recommended in case cefdinir fails. Rifampin plus clindamycin can be administered if azithromycin, clarithromycin and erythromycin therapy worsens the symptoms or does not improve the symptoms.
Guidelines for Group 2
The Group 2 patients have four options: gatifloxacin / levofloxacin / moxifloxacin, amoxicillin / clavulanate, ceftriaxone and β-lactam allergic# gatifloxacin, levofloxacin, moxifloxacin, clindamycin and rifampin. Both calculated bacteriologic and clinical efficacies of the therapies are above 91%. Bacteriologic efficacies are very high (99 to 100%). In case the therapies worsen the symptoms or do not improve the symptoms within 72 hours, reevaluation is recommended.
A word of caution for the patients suffering from acute bacterial rhinosinusitis, this article provides facts for information only. Before starting a therapy, you must contact your physician.
SAHP, an outreach program for primary care physicians and patients, is a collective effort of the American Rhinologic Society (ARS), American Academy of Otolaryngic Allergy (AAOA) and American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS). The non-profit partnership was set up in 2000, when the guidelines were unveiled for the first time.

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