Sinusitis Treatment 3.18.17 Backup

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The many "UNKNOWN" outstanding questions are examples of opportunities for outpatient clinical research in pediatric offices.

Example: My 5 year old had a high fever, profuse, purulent rhinorrhea and pink eye. He just finished amoxicillin for an ear infection a week ago. Should you prescribe amoxicillin or amoxicillin-clavulanate?

Example: Do you treat a 12 year old boy with 3 weeks of symptoms differently than a 6 year with sudden onset of severe symptoms?

Floating topic

Adverse Events

Cost

C difficile / antibiotic associated diarrhea

Antibiotic Resistance

Antibiotic Resistance is Increasing

Outpatient Antimicrobial Stewardship is essential (Click here to link to CDC for more info)

How do we treat acute bacterial sinusitis in children?

What bacteria cause sinusitis?

Pneumococcus (Images from CDC.gov)

Following Prevnar (anti-pneumococcal vaccine), is this still the most common cause of sinusitis?

Based on presumption that Prevnar reduced pneumococcus and proportionately increase Moraxella/Haemophilus, Infectious Disease Society of America guidelines recommend amoxicillin-clavulanate for first line treatment. Because there is no evidence that this shift in bacteria has occurred, American Academy of Pediatrics guidelines recommend amoxicillin. See Chow, et al, Clinical Infectious Disease 2012 and Wald, et al, Pediatrics 2013.

Moraxella (Images from CDC Red Book)

Produce beta-lactamase

Amoxicillin-clavulanate

What drug you prescribe?

How long to treat?

Amoxicillin

Clinical Indications?

Failed amoxicillin?

Conjunctivitis?

Haemophilus (Images from cdc.gov)

What kind of symptoms do they have?

Chronic

Worsening

Acute Severe

UNKNOWN: Does the presentation type have anything to do with the bacteria causing symptoms? Should each presentation be treated differently?