Sinusitis

Question 1

Sinusitis is inflammation of the ______

Answer 1

sinuses

Question 2

Acute sinusitis lasts ___ weeks

Answer 2

<4

Question 3

Acute sinusitis is predominantly ____ in nature

Answer 3

viral
Most cases do NOT require antibiotics as 98-99.5% of infections are viral.

Question 4

Most common bacterial pathogens if sinusitis is suspected to be bacterial
1
2
3

Answer 4

1. S. Pneumoniae
2. H. Influenzae
3. M. catarrhalis

Question 5

Differentiation of viral and bacterial sinusitis is based on type of and duration of symptoms:
_____ infections peak at 3 days, improve in 7-10

_____ infections last > 10-12 days, or worsen after 3-4 days

Answer 5

Viral

Bacterial

Viral & bacterial sinusitis have similar symptoms, but symptoms that
worsen or are prolonged (≥10 days) suggest bacterial involvement

Question 6

Clinical presentation of acute bacterial sinusitis
P
O
D
S

Answer 6

Pain, Pressure

Obstruction

Discharge

Smell

Question 7

Patients with symptoms of sinusitis lasting < 7 days should be offered _________ treatment

Answer 7

symptomatic relief

Question 8

Patients with symptoms of sinusitis lasting > 7 days, PODS >2, mild-moderate. should be offered _______

Answer 8

intranasal corticosteroid

Question 9

Patients with symptoms of sinusitis lasting > 7 days, PODS >2, SEVERE, should be offered _______

Answer 9

ANTIBIOTICS

Question 10

Non-drug measures to manage sinusitis involve:
1.
2.
3.
etc

Answer 10

1. irrigation with nasal saline
2. handwashing
3. warm facial compress
   rest and hydration, sleep bed elevated, avoid allergen exposure

Question 11

Symptom management for sinusitis involves
1.
2.
3.

Answer 11

1. Analgesics (reduce fever and treat localized pain)
2. Decongestants (Oxymetazoline, Xylometazoline) (may relieve congestion and increase sinus drainage. LIMIT TO 3 DAYS to prevent rebound HTN.
3. Corticosteroids (may benefit patients with chronic or allergic sinusitis or adjunct to antibiotics if severe symptoms)

Question 12

Decongestants should only be used in patients this age and above:

Answer 12

12

Question 13

1st line antibiotic therapy for sinusitis in adults and children ?

Answer 13

HD Amoxicillin

Amoxicillin is considered the antibiotic of choice due to its efficacy, safety, low cost,
narrow spectrum, & quantity of evidence (most studied antibiotic for this indication)

Amoxicillin covers S. pneumoniae & high-dose amoxicillin (1000mg TID, or 90mg/kg/day
in children) provides coverage to most penicillin resistant S. pneumonia (PRSP) strains

Question 14

Patients who are at risk of antibiotic resistance or failed initial therapy for sinusitis should be treated with ?

Answer 14

Amox-Clav (7:1 ratio formulation)

Amoxicillin-clavulanate provides broader coverage, including beta-lactamase positive
H. influenza & M. catarrhalis. However, clavulanate increases the risk of GI AEs. The
higher amoxicillin to clavulanate ratio with the BID dosing (7:1) ↓ the risk of moderate/
severe diarrhea vs TID (4:1)

Question 15

Patients with a Type I hypersensitivity to penicillin and require treatment for bacterial sinusitis should be treated with 1 of these:
1.
2.
3.

Answer 15

1. Doxycycline
2. Clarithromycin
3. Azithromycin

Question 16

Duration of therapy for bacterial sinusitis:
Adults: __ to ___ days
Children ___ to ___ days

Answer 16

Adults 5-10

Children 10-14

Question 17

The following red flags require emergency referral in sinusitis :
1.
2.
3.
4. signs of meningitis
5. new neurological findings
6. extra-local infection

Answer 17

1. severe headache
2. altered level of concisousness
3. swelling of eye/visual change