Treatment Of Acute Bacterial Rhinosinusitis Research Articles

Farklı Hekim Gruplarının Pediatrik Akut Bakteriyel Rinosinüzite Yaklaşımları

Objective: Our aim in this study is to analyze the compliance rates with current guidelines by raising awareness among pediatricians, otolaryngologists, general practitioners and family physicians about the diagnosis and treatment of acute bacterial rhinosinusitis. Methods: A survey containing 18 questions was sent to physicians working in the Marmara Region of Turkey. The responses and variables, including age, gender, duration of professional experience, specialty area, and the number of cases diagnosed in one month, were evaluated concerning the current guidelines from the American Society of Infectious Diseases Results: Totally 500 physicians were enrolled into this study. The majority of the physicians participating in the study [91,4% (n=458)] did not know how to differentiate acute rhinosinusitis from viral upper respiratory tract infection clinically. The number of physicians prescribing the correct antibiotic but at the wrong dosage was 186 (37.2%). It was observed that general physicians made more mistakes in determining the diagnosis with the correct criteria than the other specialties (p=0.03). Conclusion: There appears to be a problem of clinical inertia in the diagnosis and treatment of pediatric acute bacterial rhinosinusitis at the emergency department in Turkey, possibly due to unfamiliarity with the condition, patient overload, worries about performance fees, and failure to update medical knowledge concerning current guidelines. Increased emphasis on continuing professional education and various supportive measures for primary care physicians may help to resolve this.

Effectiveness of antral puncture and Proetz displacement procedure in acute bacterial rhinosinusitis

The development of antibiotics and topical steroids in the treatment of acute bacterial rhinosinusitis (ABRS) has not changed the attitude to active drainage, which appeared more than 200 years ago, and today in Russia is used in most medical institutions and is included in clinical guidelines. The existing studies do not answer the question about the necessity of such procedures. In this regard, the study of the effectiveness of various methods of active drainage is relevant. The aim of the study was to conduct a comparative evaluation of antral puncture and Proetz displacement procedure in the treatment of acute bacterial rhinosinusitis. Materials and methods. A total of 150 adult patients with a moderate ABRS were examined. All patients received a systemic antibiotic. One group underwent the Proetz procedure, another group underwent an antral puncture, and the third group was a control. Quality of life (SNOT-16), nasal cavity endoscopy, facial pain severity, tolerability, complications, and duration of the procedure were assessed. Results. A single puncture significantly improved QoL, reduced the severity of endoscopic manifestations on day 5-6 of treatment, and reduced facial pain 30 minutes after the procedure. In the Proetz group, the procedure had no effect on the course of the disease. Tolerability of the puncture was satisfactory, and the Proetz procedure was painless. Both procedures significantly increased the duration of the consultation. The proportion of complications obtained indicates the relative safety of the methods studied. Conclusion. There is a need to reconsider the feasibility of routine use of active drainage methods in the treatment of ABRS, since antral puncture is effective only in the presence of pain syndrome, while the Proetz method has no effect on the course of the disease.

Оценка эффективности дренирования околоносовых пазух назальным катетером в лечении острого бактериального риносинусита

There are various ways to treat acute bacterial rhinosinusitis (ABRS), the main one being systemic antibiotic therapy (SAB), which seems logical today. However, the role of the method of active noninvasive drainage of the paranasal sinuses (PNS) with a nasal catheter (NC) in the treatment of this disease is not yet completely clear. Based on the pathogenesis of acute sinusitis, there are good reasons to use it as a possible treatment option. However, clinical studies are needed to confirm the effectiveness of the method. Objective. To evaluate the effectiveness of drainage of the paranasal sinuses with a nasal catheter in the treatment of acute bacterial rhinosinusitis. Materials and methods. Adult patients with ABRS were divided into 2 groups of 50 people. In the first group, SAB, irrigation of the nasal mucosa with saline, and intranasal decongestants were prescribed, in the second group, in addition to similar treatment, the procedure for draining PNS using NC was performed. The quality of life and the severity of sinonasal symptoms were assessed using the SNOT-16; the severity of the endoscopic picture, according to the modified Lund–Kennedy score (m-LK). In addition, in the second group, complications, duration of manipulation, and pain during the procedure were assessed according to the VAS (visual analogue scale). Results. The use of NC statistically significantly (p < 0.05) reduces the severity of the disease according to the SNOT-16 and on the m-LK score on days 5–6 relative to treatment without NC, although this decrease is small. More long-term results in the groups do not differ (p > 0.05). In the second group, facial pain stopped faster than in the first group (p < 0.05). The severity of pain during the procedure with a catheter was 2,0 [1,0; 3,0] points, the procedure time was 12,0 [12,0; 13,0] minutes, complications were observed in 12% of cases. Conclusion. Treatment of OBRS with SAB in combination with NC is effective, well tolerated as well as relatively safe, but it does not affect the outcome of the disease compared to treatment with antibiotics alone. Given the effectiveness of the NC procedure with respect to facial pain, this procedure is indicated as an adjunct to the SAB in the presence of this symptom.

Efekti različitih antibiotskih terapija akutnog rinosinuzitisa

Introduction: Sinusitis is an inflammation of the paranasal sinuses and it can be infectious, allergic or autoimmune. Acute rhinosinusitis commonly has viral origin and occurs as part of the upper respiratory tract infections. The most common pathogens are Streptococcus, Pneumococcus and Haemophilus influenzae. Some inflammations may start as viral, but develop into bacterial superinfection, i.e., subsequent colonization of the bacteria in 0.5-2% of cases. Viral sinusitis lasts for 7-10 days, whereas bacterial may take longer. The aim: The aim of this study was to compare three therapeutic protocols for the treatment of acute bacterial rhinosinusitis. Materials and Methods: A prospective clinical study was conducted at the Ear, Nose and Throat Clinic, Clinical Center Nis from October 2019 to January 2020, and it involved patients with acute bacterial rhinosinusitis in whom we compared the efficiency and safety of levofloxacin administration for five and 10 days with the efficiency of amoxicillin clavulanate treatment. The study included 62 patients with documented clinical and radiological symptoms. Results: Confirmation of bacterial etiology is not routinely performed in clinical practice since it requires antral puncture or endoscopic examination of the middle nasal meatus. Consequently, the choice of antibiotic therapy is empiric. In our study, we used levofloxacin for five (500 mg once a day) and 10 days (500 mg once a day) and amoxicillin-clavulanatefor 10 days (500 mg-125 mg three times a day), and the results showed no statistically significant difference in regard to the choice of antibiotics and the duration of therapy. Conclusion: The findings of this study suggest that a short course of antibiotic treatment has similar efficiency compared to a longer course of treatment of patients with uncomplicated acute bacterial sinusitis when treatment is indicated.

Clinical Trial to Reconfirm the Efficacy and Safety of Cefetamet Pivoxil Treatment in Sinusitis Patients: A Double-Blind, Randomized, Parallel Designed, Multicenter, Active Comparator Study (CASIS Study).

To evaluate the clinical efficacy and safety of cefetamet pivoxil for the treatment of acute bacterial rhinosinusitis in Korean patients compared to treatment with cefdinir. A prospective, multicenter, randomized double-blind, comparative study was conducted by the Departments of Otorhinolaryngology-Head and Neck Surgery at 17 hospitals or universities in the Republic of Korea from March 2017 to April 2019. A total of 309 patients were screened and 249 patients participated in the study. Treatment with cefetamet pivoxil for 2 weeks showed 82.4% clinical cure and improvement rates in patients with acute bacterial rhinosinusitis compared to 84.68% in those taking cefdinir for 2 weeks, showing that cefetamet pivoxil administered twice a day for 2 weeks was as effective as cefdinir 3 times a day for 2 weeks for the treatment of acute bacterial rhinosinusitis. The overall adverse reaction rates of both drugs were 10.56% in the cefetamet pivoxil group and 15.49% in the cefdinir group, without serious adverse events or drug reactions. Cefetamet pivoxil twice a day was as efficacious and safe as cefdinir 3 times a day for the treatment of acute bacterial rhinosinusitis, which suggested that cefetamet pivoxil may be a suitable alternative to cefdinir.

Evaluation of the clinical efficacy of local antibacterial therapy in the treatment of acute bacterial rhinosinusitis

To evaluate the clinical efficacy of Polydexa with phenylephrinum in the complex treatment of moderate acute bacterial rhinosinusitis. The article presents the results of a clinical study of 100 patients with moderate acute bacterial rhinosinusitis 37 (37%) men, 63 (63%) women aged 15 to 53 years. The patients were randomized into 2 groups of 50 people each. In the study group, patients received systemic antibiotic therapy and a topical nasal spray of Polydexa with phenylephrinum. The control group received systemic antibacterial therapy and long-acting local decongestants. The evaluation criteria were statistically significant differences in clinical and laboratory parameters of the control and main groups. The pronounced anti-inflammatory, antimicrobial effects of the drug were confirmed; conclusions were drawn about the clinical efficacy, tolerability, safety of Polydexa with phenylephrinum and allows to achieve complete resolution of the pathological process in more cases.

The use of roxithromycin in the treatment of acute bacterial rhinosinusitis

According to epidemiological studies, bacterial rhinosinusitis is one of the most common pathologies of ENT-organs on an upward trend. Rhinosinusitis significantly reduces the patient’s quality of life and, in the absence of timely treatment, can lead to serious complications. Macrolide antibiotics are effective drugs in the treatment of rhinosinusitis. Roxithromycin (Esparoxy), one of modern macrolides, showed good results. The article provides characteristics of this drug, reflects the high quality of efficacy and safety in the treatment of bacterial rhinosinusitis, with due regard to the experience of the Russian and foreign authors.

The inhalation antibioticotherapy of acute bacterial rhinosinusitis

Epidemiological studies conducted throughout the world show that the inflammatory diseases of the nasal cavity and paranasal sinuses are the leading cause of otorhinolaryngology (ENT) hospital admissions and outpatient clinic referral. Although the most common cause of acute rhinosinusitis is viral infection, antibiotics are prescribed in more than 80% of cases, which may lead to the development of antimicrobial resistance. The topical inhalation therapy with the inhalation Complex «PARI SINUS device» (сompressor and nebulizer) may provide better treatment options for patients who suffer from the diseases of the nasal cavity and paranasal sinuses. Purpose of the study is to evaluate the efficacy of topical inhalation treatment of acute bacterial rhinosinusitis using pulsating aerosol in comparison with systemic antibiotic therapy. Materials and methods. 60 adult patients at the age from 19 to 62 years with the diagnosis uncomplicated moderate acute bacterial rhinosinusitis has been included in opened randomized controlled trial. 30 patients have been with the inhalation therapy by the combined drug Fluimucil® antibiotic IT (thiamphenicol glycinate acetylcystein, Zambon) using PARI SINUS device during 7 days. Controls – 30 patients have been treated with antibiotic therapy of acute bacterial rhinosinusitis using 875/125 mg oral amoxicillin/clavulanate twice daily for 7 days. The result was evaluated by the dynamics of the symptoms of acute bacterial rhinosinusitis (nasal congestion, blockage, facial pain and reduction of smell), active anterior rhinomanometry and nasal endoscopy. Results. For main symptoms of acute bacterial rhinosinusitis was no significant benefit of antibiotic therapy as compared to topical inhalation therapy using pulsating aerosol. Both treatment options were effective against acute bacterial rhinosinusitis, which is confirmed by the improvement of symptoms, active anterior rhinomanometry and nasal endoscopy. Conclusion. The topical nebulizer therapy of acute bacterial rhinosinusitis may provide better treatment options, because systemic antibiotics can be associated with different adverse effects.

The inhalation therapy of moderate forms of acute bacterial rhinosinusitis

Epidemiological studies conducted throughout the world show that the inflammatory diseases of the nasal cavity and paranasal sinuses are the leading cause of otorhinolaryngology (ENT) hospital admissions and outpatient clinic referral. Although the most common cause of acute rhinosinusitis is viral infection, antibiotics are prescribed in more than 80% of cases, which may lead to the development of antimicrobial resistance. The topical inhalation therapy with PARI SINUS device (сompressor Pari Sinus and Pari LC Sinus nebuliser) may provide better treatment options for patients who suffer from the diseases of the nasal cavity and paranasal sinuses. Purpose of the study is to evaluate the efficacy of topical inhalation treatment of acute bacterial rhinosinusitis using pulsating aerosol in comparison with systemic antibiotic therapy. Materials and methods. 60 adult patients at the age from 19 to 62 years with the diagnosis uncomplicated moderate acute bacterial rhinosinusitis has been included in opened randomized controlled trial. 30 patients have been treated with nasal nebulizer inhalation with N-acetyl-cysteine in combination with thiamphenicol on 500 mg once daily for 7 days using pulsating aerosol. Pulsating aerosol was obtained by PARI SINUS device. Controls - 30 patients have been treated with antibiotic therapy of acute bacterial rhinosinusitis using 875/125 mg oral amoxicillin/clavulanate twice daily for 7 days. The result was evaluated by the dynamics of the symptoms of acute bacterial rhinosinusitis (nasal congestion, blockage, facial pain and reduction of smell), active anterior rhinomanometry and nasal endoscopy. Results. For main symptoms of acute bacterial rhinosinusitis was no significant benefit of antibiotic therapy as compared to topical inhalation therapy using pulsating aerosol. Both treatment options were effective against acute bacterial rhinosinusitis, which is confirmed by the improvement of symptoms, active anterior rhinomanometry and nasal endoscopy. Conclusion. The topical nebulizer therapy of acute bacterial rhinosinusitis may provide better treatment options, because systemic antibiotics can be associated with different adverse effects.

RHINOSINUSITIES THERAPY: PRESENT AND FUTURE

The article presents the aspects of medical therapy of rhinosinusitis from the point of view of the disease pathogenesis. It is shown in which cases the indication of a systemic antibacterial therapy, the choice of optimal antibiotic given the current situation with antibiotic resistance and sensitivity is required. The author cites one recent study, which proved that the sensitivity of pneumococcus and Haemophilus influenzae to amoxicillin and amoxicillin/clavulanate is 100%, which defines their indication as first-line drugs for treatment of acute bacterial rhinosinusitis and acute exacerbation of chronic rhinosinusitis. The article provides information about clinical research in recent years and new trends of medical treatment of chronic rhinosinusitis with the use of corticosteroids, antileukotriene drugs and monoclonal antibodies.

The topical treatment of acute bacterial rhinosinusitis

The topical treatment of acute bacterial rhinosinusitis

RECENT OPTIONS IN MEDICAL TREATMENT OF PATIENTS WITH MODERATE TO SEVERE BACTERIAL RHINOSINUSITIS

Despite the fact that in the majority of cases rhinosinusitis is known to be viral, bacterial infections still play their role. Bacterial etiology for sinonasal pathology usually means more severe condition, chronic forms and frequent recurrence. Treatment of acute bacterial rhinosinusitis with systemic antibiotics is a challenging question. Unappropriate use of systemic antibiotics not only leads to individual treatment failure, but also causes global epidemiologic issues such as antibiotic resistance. The article reviews the role of respiratory fluoroqionolones in medical treatment of patients with moderate to severe bacterial rhinosinusitis.

Low-frequency ultrasound in the treatment of acute bacterial rhinosinusitis in children

Low-frequency ultrasound in the treatment of acute bacterial rhinosinusitis in children

A study of the efficacy and safety of new cephalosporin in the treatment of acute bacterial rhinosinusitis

Acute rhinosinusitis is leading in frequency of antibiotic prescribing all over the world. At the same time the problem of antibiotic resistance and safety of antimicrobial drugs becomes more relevant and international. The article describes the basic mechanisms of bacterial resistance and growth of side effects when using macrolides, respiratory fluoroquinilones and β-lactam antibiotics of different types. Formation of IgE-mediated cephalosporin allergy is associated with the side R1 chain. The R1 structure of cephalosporins I and II generations is similar to penicillins, thus creating conditions for cross-allergy progression. R1 of cephalosporins III and IV generations is represented by a qualitatively different chemical compound (aminothiazol-oxime group) that increases the level of tolerance to these antibiotic types. The data of surveillance study are given to evaluate the efficacy and safety of the new drug Spectracef (active substance is cephalosporin of III generation Cefditoren) when treating acute bacterial rhinosinusitis on an outpatient basis.

Estudio sobre eficacia y seguridad de azitromicina vs amoxicilina + ácido clavulánico en el tratamiento de rinosinusitis bacteriana aguda

Introduction. The cornerstone for the treatment of acute bacterial rhinosinusitis (ABRS) is the use of penicillins and macrolides. Objective. To prove that azithromycine provides the same or better results than amoxicillin / clavulanic acid in children with ABRS. Methodology. Comparative, randomized, prospective and experimental phase IV study (post-marketing) of 50 patients, 3 to 11 years of age with symptoms of ABRS (25 patients per group of treatment), according to the Sinusitis Committee of the American Academy of Otolaryngology and Head and Neck Surgery, i.e.: the presence of 2 major factors or one major and two minor factors of this pathology. The response and therapeutic effectiveness were determined with the following criteria: cure, improvement or failure. Patients were randomized to receive azithromycine for 3 days or amoxicillin + clavulanic acid for 10 days. Results. Every patient had major and minor factors of ABRS. At the end of treatment and of follow-up, 96% of patients in the azithromycine group were cured. In the group who received amoxicillin/clavulanate, 92% were cured. There were only 3 instances of side effects, one in the azithromycine group unrelated to the drug and two in the group treated with amoxicillin/clavulanate: mild abdominal pain and loose stools. Conclusions. Efficacy of azithromycine and amoxicillin/clavulanate is similar for the treatment of uncomplicated ABRS in children. The advantage of a 3 day treatment with azithromycine is an important factor for the adherence.

Moxifloxacin five‐day therapy versus placebo in acute bacterial rhinosinusitis

To evaluate the efficacy and safety of moxifloxacin in the treatment of acute bacterial rhinosinusitis (ABRS). Prospective, multicenter, randomized, double-blind, phase III trial. Patients with ABRS defined by clinical, radiologic, and bacteriologic criteria were recruited to the study. Study treatments were 400 mg of oral moxifloxacin or a matching placebo daily for 5 days. The primary end point was clinical response at test-of-cure, 1 to 3 days after the end of therapy in the modified intent-to-treat (mITT) population (patients with positive culture for one of five prespecified pathogens). Secondary efficacy variables included patient-reported symptom improvement measured using the Sino-Nasal Outcome Test-16 (SNOT-16), and concomitant medication use. The mITT population consisted of 118 patients (moxifloxacin, n = 73; placebo, n = 45). Clinical success rates were numerically higher for moxifloxacin (78.1%, 57/73) versus placebo (66.7%, 30/45); (P = .189). Significantly greater mean reductions in SNOT-16 scores occurred in moxifloxacin- versus placebo-treated patients (-17.54 vs. -12.83; P = .032). Overall concomitant medication use was lower in moxifloxacin versus placebo patients (38.4%, 28/73 vs. 55.6%, 25/45 respectively). Premature discontinuation due to insufficient therapeutic effect was significantly lower in moxifloxacin- versus placebo-treated patients (8.2%, 6/73 vs. 22.2%, 10/45; P = .031). The rate of treatment-emergent adverse events in the ITT population was similar between arms (moxifloxacin 38.2%, 96/251; placebo 40.7%, 50/123). Although moxifloxacin 5-day therapy for ABRS was not statistically superior to placebo for the primary end point, patients who received moxifloxacin had significantly greater improvements in health outcomes and used fewer concomitant medicines than patients treated with placebo, while experiencing no increase in adverse events.

Moxifloxacin in the treatment of acute bacterial rhinosinusitis: Results of a multicenter, non-interventional study

Conclusion: Moxifloxacin was generally well tolerated and highly effective in the treatment of acute bacterial rhinosinusitis (ABS). The incidence of adverse events (AEs) and adverse drug reactions (ADRs) was low. The effectiveness, safety, and tolerability information collected in this study confirm the clinical safety profile of moxifloxacin and its benefit as a treatment option for ABS. Objective: To assess the effectiveness, safety, and tolerability of moxifloxacin under daily life treatment conditions in patients with ABS. Methods: The study was carried out in China between September 2005 and May 2007. Patients with ABS were treated with moxifloxacin tablets 400 mg once daily for a duration that was left to the physician's discretion. Data were collected on demography, diagnosis of infection, pretreatment, concomitant diseases and medications, moxifloxacin therapy, course of symptoms during investigations, and final assessment of therapy. Results: In all, 578 patients with ABS treated with moxifloxacin were valid for effectiveness analysis. An improvement was observed in 98.8% (n = 571/578) of the patients. Cure was documented in 89.4% (n = 517/578) of the patients. The physicians' overall tolerability rating was ‘very good’ or ‘good’ in 92.9% (n = 537/578) of patients. The incidence rates of AEs and ADRs were 1.5% (n = 10/681) and 0.6% (n = 4/681), respectively. No serious AE was reported.

Staphylococcus aureus Is a Major Pathogen in Acute Bacterial Rhinosinusitis: A Meta-Analysis

Acute bacterial rhinosinusitis is a common health problem in the United States. Appropriate recommendations for the treatment of acute bacterial rhinosinusitis are based on the prevalence and expected antimicrobial susceptibilities of specific pathogens. A meta-analysis was performed on the English language literature from the period 1990-2006, including prospective studies of antibiotic therapy for acute bacterial rhinosinusitis for which sinus cultures were required in the form of either maxillary sinus taps or middle meatal cultures. Weighted mean culture rates for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus were abstracted from the included articles and compared according to culture technique. Culture rates (i.e., the percentage of patients with positive culture results) were 32.7% for S. pneumoniae, 31.6% for H. influenzae, 10.1% for S. aureus, and 8.8% for M. catarrhalis. No statistically significant difference was seen between the culture rates for S. aureus and M. catarrhalis. Analysis of the effect of culture technique on the culture rates revealed no statistically significant difference. The prevalence of S. aureus among sinus cultures warrants its reconsideration as a major pathogen in acute bacterial rhinosinusitis. As a result, increasing trends of drug-resistant strains may complicate antibiotic recommendations.

Oral β-lactams in the treatment of acute bacterial rhinosinusitis

Acute bacterial rhinosinusitis (ABRS) is a well-known complication of viral upper respiratory tract infection and is associated with a significant socioeconomic burden. Difficulties in diagnosis, a substantial spontaneous resolution rate, and growing concerns regarding antimicrobial resistance make the proper management of ABRS quite challenging. Treatment guidelines have been developed, taking into account the major bacterial pathogens, rates of antimicrobial resistance, spontaneous resolution rates, and pharmacokinetic and pharmacodynamic considerations. Optimal choices for initial treatment of ABRS in patients without prior antibacterial exposure include the oral β-lactam agents amoxicillin/clavulanate, cefdinir, cefpodoxime, and cefuroxime. Clinicians are encouraged to consider the local pathogen distribution and rates of antibacterial resistance in selecting therapy for ABRS.

Guidelines for management of acute bacterial rhinosinusitis: Impact on Quebec physicians’ prescriptions for antibiotics

To determine the impact of widely distributed guidelines on the diagnosis and treatment of acute bacterial rhinosinusitis (ABRS) on physician prescribing patterns. The overall numbers of prescriptions were compared between Quebec and the rest of Canada (excluding Quebec) using IMS Health Canada Canadian Disease and Therapeutic Index and CompuScript data on the antibiotics use for ABRS for the 3-month period immediately following the distribution of the guidelines and the corresponding period the previous year. In comparison to the corresponding period during the previous year, antibiotic prescriptions for ABRS decreased 5.5% overall in Quebec compared with a 30.1% increase recorded in Canada excluding Quebec. While the reduction in antibiotics use noted may be multifactorial, it nevertheless suggests that it may be able to affect physician prescribing habits. Knowledge of the effectiveness of this method of distribution of guidelines could be used to plan more effective means of distribution of future guidelines.