Systemic antibiotic therapy of patients with acute bacterial sinusitis taking into account resistance

Acute rhinosinusitis is one of the most common diseases in the world. According to statistics, about 10 million cases are registered in Russia every year.Acute bacterial rhinosinusitis (ABRS) in most cases develops as a result of an acute respiratory viral disease, proceeds easily and it does not require antibiotic therapy. However, it significantly reduces the patient's quality of life in cases of moderate and severe disease, and in the absence of timely treatment, can lead to intracranial complications (meningitis, encephalitis, intracranial abscesses, etc.) and orbital (reactive edema of the eyelid, phlegmon of the orbit, periorbital abscesses, etc.). To avoid complications, with exacerbation of rhinosinusitis, it is necessary to choose the right antibiotic therapy, taking into account the resistance of the microorganisms that caused the disease.The article describes the differential diagnosticprinciples of bacterial rhinosinusitis according to the latest recommendations and research in this area, the most common antibiotic-resistant pathogens in the practice of an ENT doctor are presented, the issue of choosing the correct systemic antibiotic therapy for the treatment of patients with moderate and severe acute bacterial rhinosinusitis is considered according to modern data on the sensitivity of bacterial pathogens to antibacterial drugs prescribed in the otorhinolaryngologist's practice. The article presents data on a new universal cephalosporin of the 3rd generation (the active ingredient is cefditoren), as a second- and third-line drug, due to its high activity against most causative agents of acute bacterial rhinosinusitis, and clinical observation using the above antibacterial agent within the framework of the considered topics.

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)

Objective: 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. Methods: 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. Results: 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. Conclusions: 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.

Bilateral Longus Colli Abscesses as a Complication of Advanced Bacterial Rhinosinusitis

Known complications of acute bacterial rhinosinusitis include retropharyngeal abscess, cavernous sinus thrombosis, intracranial abscess, and associated sequelae. We describe the case of a patient with longus colli abscess formation resulting from acute pansinusitis, complicated by bilateral cavernous sinus thrombosis in the setting of concurrent viral pneumonitis, severe sepsis, and a large area cerebral infarction. The bilateral longus colli abscesses were drained via stereotactic image-guided endonasal sinus surgery, yielding Staphylococcus hominis in culture. The described disease progressed rapidly over a 2-week course amid the COVID-19 pandemic.

Safety of a New Sinus Irrigation Device in Rhinosinusitis: A Pilot Study

Background: Puncture and lavage of the paranasal sinuses, previously the primary treatment for unresponsive acute bacterial rhinosinusitis before surgery, has been abandoned due to procedural discomfort and advancements in antibiotic efficacy and endoscopic surgery. The rise in antibiotic-resistant bacteria has renewed the interest in minimally invasive sinus lavage to both avoid aggressive surgical interventions and identify appropriate antibiotic therapy. In this article, we describe the safety and feasibility of a new device in human patients and evaluate its efficacy as a treatment before the traditional sinus surgery in acute rhinosinusitis. Methods: The device with its seeker-shaped guiding tube and rotating wire can enter the sinus cavity through the natural ostium, pulverize the inspissated mucus, and enable lavage and culture sampling without the need for sinus puncturing. It was tested in 6 patients with chronic sinusitis under general anesthesia during endoscopic sinus surgery and in additional 10 patients with maxillary acute bacterial rhinosinusitis in outpatient settings under local anesthesia. Results: The device enabled rapid, efficient, and atraumatic insertion of the wire into the occluded sinuses. The rotating wire permitted pulverization of the thick mucus, which enabled irrigation without mucosal damage or adverse events. Overall, 9 of 10 patients with acute bacterial rhinosinusitis demonstrated remarkable improvements and were discharged the following day with no acute symptoms. The visual analog scale score for pain dropped from 8.9 to 0.4. The remaining one patient underwent endoscopic sinus surgery subsequently. None of the patients treated during endoscopic sinus surgery developed any adverse events.

Topical therapy in the treatment of patients with acute rhinosinusitis in adults

Acute rhinosinusitis is one of the most common diseases in the world, characterized by acute inflammatory processes in the nasal cavity and paranasal sinuses, lasting less than 4 weeks. According to statistics, in Russia, this disease is recorded in 6–15% of the population annually, in European countries in every seventh person, while there is a tendency to an increase in the incidence. Acute viral rhinosinusitis has the highest incidence among all rhinosinusitis and occurs in most patients in a mild form, however, untimely treatment of inflammation of the nasal mucosa can lead to obstruction of the natural anastomoses, impaired physiological ventilation and drainage of the paranasal sinuses, stagnation of secretions with further development acute bacterial rhinosinusitis. The overuse of local vasoconstrictor drugs (intranasal decongestants) leads to the development of drug-induced rhinitis, long-term imbalance of autonomic innervation of the nasal mucosa and edema, called "rebound syndrome". In the article we consider the issues of etiology, pathogenesis, features of the course of rhinosinusitis. The principles of differential diagnosis of viral and bacterial rhinosinusitis are stated, taking into account the latest recommendations and research in this area. The features of the use of the most frequently used topical preparations in acute rhinosinusitis in the practice of an ENT doctor have been analyzed.

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

Aim.To evaluate the clinical efficacy of Polydexa with phenylephrinum in the complex treatment of moderate acute bacterial rhinosinusitis. Materials and methods.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. Results and conclusion.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.

Accuracy of signs, symptoms and blood tests for diagnosing acute bacterial rhinosinusitis and CT-confirmed acute rhinosinusitis in adults: protocol of an individual patient data meta-analysis

IntroductionThis protocol outlines a diagnostic individual patient data (IPD) meta-analysis aimed at developing simple prediction models based on readily available signs, symptoms and blood tests to accurately predict acute bacterial rhinosinusitis and CT-confirmed (fluid level or total opacification in any sinus) acute rhinosinusitis (ARS) in adults presenting to primary care with clinically diagnosed ARS, target conditions associated with antibiotic benefit.Methods and analysisThe systematic searches of PubMed and Embase of a review on the accuracy of signs and symptoms for diagnosing ARS in ambulatory care will be updated to April 2020 to identify relevant studies. Authors of eligible studies will be contacted and invited to provide IPD. Methodological quality of the studies will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Candidate predictor selection will be based on knowledge from existing literature, clinical reasoning and availability. Multivariable logistic regression analyses will be used to develop prediction models aimed at calculating absolute risk estimates. Large unexplained between-study heterogeneity in predictive accuracy of the models will be explored and may lead to either model adjustment or derivation of separate context-specific models. Calibration and discrimination will be evaluated to assess the models’ performance. Bootstrap resampling techniques will be used to assess internal validation and to inform on possible adjustment for overfitting. In addition, we aim to perform internal–external cross-validation procedures.Ethics and disseminationIn this IPD meta-analysis, no identifiable patient data will be used. As such, the Medical Research Involving Humans Subject Act does not apply, and official ethical approval is not required. Findings will be published in international peer-reviewed journals and presented at scientific conferences.PROSPERO registration numberPROSPERO CRD42020175659.