Updated Guidelines Provide Diagnosis and Treatment Recommendations for Bacterial

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Title: Updated Guidelines Provide Diagnosis and Treatment

Recommendations for Bacterial Sinusitis

" Updated Guidelines Provide Diagnosis and Treatment Recommendations

for Bacterial Sinusitis "

Guidelines Underscore Importance of Selecting the Most Effective

Antibiotics for the 20 Million Infections Each Year WASHINGTON, DC --

January 21, 2004 -- Updated guidelines released today by the Sinus

and Allergy Health Partnership (SAHP) highlight the importance of

accurate diagnosis and treatment of acute bacterial rhinosinusitis

(ABRS), commonly known as sinusitis. The guidelines, published in

this month's issue of Otolaryngology-Head and Neck Surgery, provide

recommendations for accurate diagnosis and treatment of sinusitis. A

panel of expert physicians developed the guidelines to ensure the

appropriate diagnosis and treatment of bacterial sinusitis in adult

and pediatric patients. There are approximately 20 million cases of

sinusitis reported each year, which cost the United States economy

nearly $3.5 billion dollars annually. Furthermore, sinusitis is the

fifth most common diagnosis for which an antibiotic is prescribed.

These new guidelines are driven by evolving trends seen in antibiotic

resistance, as well as the availability of new therapeutic options,

such as high-dose amoxicillin/clavulanate (Augmentin XR™) and

cefdinir (Omnicef®). SAHP first issued treatment guidelines for

sinusitis in 2000 to reduce the prescribing of antibiotics for viral

infections while helping physicians select the most appropriate

antibiotics when bacterial sinus infections are present. " As

antibiotic resistance continues to be a problem, treatment guidelines

should evolve as well. The updated guidelines provide the most

current information on disease management, antimicrobial

susceptibility patterns and therapeutic options, " said Jack Anon,

M.D., lead author of the guidelines and associate clinical professor

at the University of Pittsburgh. " The guidelines also support the

ongoing efforts to educate providers and patients about the

appropriate use of antibiotics and the need to choose the right

antibiotic. " Bacterial vs. Viral Infections The widespread use of

antibiotics to treat common viral illnesses such as colds, the flu

and viral sinusitis is one of the primary causes of antibiotic

resistance. Antibiotics kill bacteria, not viruses, and therefore

should not be used for viral illnesses. However, it can be

challenging to differentiate between viral and bacterial sinusitis

because the clinical features of the two infections are quite

similar. Diagnosis The guidelines provide diagnostic information to

assist primary care physicians in distinguishing between viral and

bacterial sinusitis. According to the guidelines, bacterial sinusitis

typically develops as a complication of a viral upper respiratory

infection (URI), such as the common cold. In general, a diagnosis of

bacterial sinusitis may be made in adults or children with a viral

URI that is no better after 10 days or worsens after five to seven

days and is accompanied by some or all of the following symptoms:

nasal drainage, nasal congestion, facial pressure/pain (especially

when the pain occurs on one side and is focused in the region of a

particular sinus), post-nasal drainage, reduced sense of smell,

fever, cough, fatigue, dental pain in the jaw and ear

pressure/fullness. Choosing An Appropriate Antibiotic When a

diagnosis of bacterial sinusitis is made, selection of the most

effective antibiotic is essential in the fight against antibiotic

resistance. To aid physicians in this selection, the guidelines

classify the most commonly used antibiotics into categories of

expected clinical efficacy (based on a mathematical model) against

the bacteria that most often cause ABRS - Streptococcus pneumoniae,

Haemophilus influenzae and Moraxella catarrhalis. " These guidelines

should serve as the definitive resource for physicians treating

sinusitis, " said Dr. Anon. " The guidelines are crafted to help

prescribers select those antibiotics with demonstrated efficacy

against Streptococcus pneumoniae, including resistant strains. "

Guideline Categories In addition to efficacy, the guidelines state

that selection of the most appropriate antibiotic for sinusitis

therapy should be based on disease severity, the rate of disease

progression and recent antibiotic exposure. The guidelines divide

sinusitis into two categories of severity-mild and moderate. Since

recent use of antibiotics increases the risk of infection due to

resistant organisms, the guidelines also divide patients according to

antibiotic exposure in the previous 4-6 weeks. In short, the

guidelines recommend the following: Recommended Treatment Options for

Adults with ABRS Mild Disease with No Recent Antibiotic Use (Past 4-6

Weeks) Mild Disease with Previous Antibiotic Use or Moderate Disease

· amoxicillin/clavulanate (1.75g-4g/250mg/day) · amoxicillin (1.5g-

4g/day) · cefpodoxime proxetil · cefuroxime axetil · cefdinir · high-

dose amoxicillin/clavulanate (4g/250 mg/day) · respiratory

fluoroquinolones (gatifloxacin/ levofloxacin/moxifloxacin) ·

ceftriaxone " It is important to be judicious about choosing the

appropriate antibiotic, " stated Dr. Anon. " By choosing the

appropriate antibiotic, bacteria is eradicated and there is a

decreased chance of resistance. " SOURCE: Cohn & Wolfe