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Understanding the diagnosis and treatment of acute sinusitis

1 August 2005


Context: Excessive and inappropriate use of antibiotics has been identified as a leading cause in the emergence of resistant pathogens. Acute sinusitis is one of the most prevalent infections in the United States, and is commonly treated with antibiotics despite the fact that its' most common cause is considered viral.

Objective: The objective of this study was to investigate which elements are important for accurate diagnosis and appropriate prescription of antibiotics for patients with acute bacterial sinusitis. This study investigated diagnostic and treatment patterns of clinicians.

Design: Qualitative research using a provider questionnaire. The questionnaire consisted of multiple choice questions pertaining to the diagnosis and treatment of acute sinusitis.

Main Outcome Measures: The primary outcome of interest was to better understand the elements of the patients' history and physical exam that are important in diagnosis and treatment of acute bacterial sinusitis. A literature review was performed to establish current guidelines for the diagnosis and treatment of acute bacterial sinusitis. The provider responses to the questionnaire were then compared to the current established criteria.

Results: A total of 51 providers completed the questions pertaining to the diagnostic factors for ABRS. The most important elements of the history of present illness were purulent nasal discharge (43%), facial pain or pressure (61 %), maxillary dental pain (41 %), and duration of symptoms (69%). A total of53% of providers chose sinus tenderness on palpation as the most important exam finding in the diagnosis of ABRS. Important elements of the physical exam included presence of a fever (51 %), purulent nasal discharge (43%), and lymphadenopathy (43%). A total of 48 responses were collected in the clinical case section. On the basis of response rate, the preferred treatment for clinical case #1 was amoxicillin 500 mg tid xl0 days with a total of 45.8% of the total responses. The treatment option with the most responses in clinical case #2 was fluids and decongestants with 52.1 % of the total responses. The preferred treatment for clinical case #3, based on number of responses was also fluids and decongestants with 68.8% of responses.

Conclusion: The overall results suggest that a large percentage of clinicians are able to differentiate between viral vs. bacterial causes of acute sinusitis. The majority of clinicians are carefully evaluating each clinical case and choosing the most appropriate treatment. However, there is still a large percentage that may not be using the recommended guidelines to evaluate each clinical case, and thus ultimately treat inappropriately.


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