Acute Bacterial Sinusitis

Respiratory Tract: AcuteBacterialSinusitis Respiratory Tract: Acute Bacterial Sinusitis Respiratory Tract: Acute Bacterial Sinusitis CLINICAL AND THERAPEUTIC ALGORITHM RISK FACTORS RECOMMENDED REGIMENS

1a. CLINICAL AND THERAPEUTIC ALGORITHM Antibiotics areindicated if the RISK FACTORS Presence of Risk patient has ANY of the Factors for 1a. Antibiotics are indicated if the following: Presence of Risk Antibiotic patient has ANY of the • Symptoms lasting ≥10 Factors for Resistance: following:days without clinical Antibiotic • Age > 65 • Symptoms lasting ≥ 10 improvement Resistance:• Antibiotics

ORdays without clinical • Age > 65 within last30 • improvement Severesymptoms at onset • Antibiotics days

ORlasting • within last 30 Hospitalization • Severe symptoms at onset ≥ 3days[Fever (≥102 °F), days within last 5 lasting severe facial pain,or • Hospitalization days ≥ 3 days [Fever (≥ 102 °purulent discharge] F), • within last 5 ImmunosevereOR facial pain, or days compromised • purulent discharge] Newonsetfever,severe • Immuno-OR

ORheadache,orincrease • compromised Fever> 102°F • New onset fever, severe nasal dischargeafter 5-6 OR with signs of headache, or increase days following initial • Fever > 102°F systemic illness nasal discharge after 5 improvement -6 with signs of days following initial improvement 1b. If thepatient does not meet thiscriteria likelyviral and systemic illness None of the above None of the above risk factors for antibiotic 1b. If the patient does not meet self-limiting. May provide risk factors for resistance this criteria likely viral and self-limiting. May provide symptom relief. • Reduce nasal symptoms: antibiotic resistance AND symptom relief.topical or nasal No feveror signsof • Reduce nasal symptoms: decongestants,intranasal AND systemic illness topical or nasal corticosteroids,intranasal No fever or signs of decongestants, intranasal saline systemic illness corticosteroids, intranasal 2.Ifnoimprovement after3to5 saline days ofantibiotic therapy 2. If no improvement after 3 to 5 switch to an alternativeagent days of antibiotic therapy from a differentantibioticclass switch to an alternative agent CrCl= creatinineclearance;H= hour(s);PO= by mouth; Q=every from a different antibiotic class

RECOMMENDED REGIMENS Initial EmpiricAntibioticTherapy:

Amoxicillin/clavulanate PO:

Initial EmpiricAntibioticTherapy:

CrCl >30ml/min: 2000/125 mg‡ Amoxicillin/clavulanate Q12H PO: CrCl > 30 ml/min: 2000/125 mg‡CrCl10 – 29ml/min: 875/125mg Q12H Q12H CrCl 10 – 29 ml/min: 875/125 mg CrCl<10ml/min: 2000/125‡ mg Q12H Q24H CrCl < 10 ml/min: 2000/125 Alternatives*: ‡ mg Q24H Moxifloxacin 400mgPOQ24H Alternatives*: Treat for7to10days Moxifloxacin 400 mg PO Q24H Treat for 7 to 10 days

Norisk for AntibioticResistance:

Amoxicillin/clavulanatePO:

Norisk for AntibioticResistance:

CrCl>30ml/min: 875/125mgQ12H Amoxicillin/clavulanatePO:CrCl 10–29ml/min: 500/125mg CrCl > 30 ml/min: 875/125 mg Q12H Q12H CrCl 10–29 ml/min: 500/125 mg CrCl<10ml/min: 875/125mgQ24H Q12H Alternatives*: CrCl < 10 ml/min: 875/125 mg Q24H Doxycycline100mgPOQ12H Alternatives*: Treatfor5 to 7days Doxycycline 100 mg PO Q12H Treat for 5 to 7 days

‡Pharmacy doesnotcarry amoxicillin/clavulanate2000/125mgtablets.Order875/125mgtabletsofamoxicillin/clavulanate CrCl= creatinine clearance; H= hour(s); PO= by mouth; Q= every AND 1000mgtabletsofamoxicillin (total amoxicillin/clavulanate=1,875/125mgperdose). ‡Pharmacy doesnotcarry amoxicillin/clavulanate2000/125 mg tablets. Order 875/125 mg tablets of amoxicillin/clavulanate AND 1000 mg tablets of amoxicillin *Macrolides,trimethoprim-sulfamethoxazole,and2ndor3rdgeneration cephalosporins are not recommendeddueto (total amoxicillin/clavulanate = 1,875/125 mg per dose). increasingrates of antimicrobial resistance.

*Macrolides, trimethoprim-sulfamethoxazole, and 2nd or 3rd generation cephalosporins are not recommended due to increasing rates of antimicrobial resistance.

References:

1. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012; 54:e72.

References:

1. Chow AW, Benninger MS,BrookI,etal.IDSAclinical practiceguideline foracutebacterial adults. Clin Infect Dis. 2012; 54:e72. rhinosinusitis in children and PAGE 16