Page 29 - Christiana Care Focus November 2018

TABLE 2. TREATMENT RECOMMENDATIONS3,5
ADULT TREATMENT RECOMMENDATIONS
Preferred Therapy
Alternative Therapy for Severe Beta-Lactam Allergy
Amoxicillin/Clavulanate
Non-type 1 Penicillin Allergy
Cefpodoxime Cefuroxime axetil Cefdinir
Type 1 Penicillin Allergy
Doxycycline
PEDIATRIC TREATMENT RECOMMENDATIONS
Preferred Therapy
Alternative Therapy for Severe Beta-Lactam Allergy
Amoxicillin
Non-type 1 Penicillin Allergy
Cefuroxime axetil Cefdinir suspension Cefpodoxime suspension
Type 1 Penicillin Allergy
< 8 years old: Clindamycin suspension > 8 years old: Doxycycline
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Although national guidelines recommend the use of a second or third generation cephalosporin plus clindamycin for patients
with non-type 1 penicillin allergies due to variable rates of
S. pneumoniae resistance, the 2017 Christiana Care antibiogram shows 100% susceptibility of S. pneumoniae isolates to third generation cephalosporins.5 Therefore, the use of second or third generation cephalosporins alone is recommended at Christiana Care due to local susceptibility rates and risks associated with clindamycin treatment.3 If a patient has a severe type 1 penicillin allergy, doxycycline may be used as an alternative.3,5 Treatment with macrolides should be avoided as a result of increased resistance rates of S. pneumoniae.3,5 Sulfamethoxazole/trimethoprim should be avoided due to both S. pneumoniae
and H. influenzae resistance.3,5
References
Conclusion
Acute rhinosinusitis has a substantial impact on our society each year. Accounting for more than 30 million outpatient visits in the United States annually, it is imperative that ARS is diagnosed and treated appropriately. Both viral and bacterial ARS are initially managed with non-antibiotic therapy targeted at patient specific symptoms, but only bacterial ARS should be treated with antibiot- ics. At Christiana Care, the preferred antibiotic therapy for bac- terial ARS is amoxicillin/clavulanate in adults and amoxicillin in children. In an effort to decrease antibiotic use prescribers should employ a “watchful waiting” technique until they are certain of bacterial etiology. As antibiotic resistance continues to develop, antibiotic stewardship is crucial in preventing further resistance. 
1. AringAM,ChanMM.Currentconceptsinadultacuterhinosinusitis.AmFamPhysician.2016;94(2):97-105.
2. Rosenfield RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngology- Head and Neck Surgery. 2015; 152(25):S1-S39. 3. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012; 54: e72-e112.
4. RadojicicC.Sinusitis.ClevelandClinic.Dec2017.AccessedSept9,2018.
5. ChristianaCareHealthSystemAmbulatoryTreatmentGuidelines:AcuteUncomplicatedRhinosinusitis.July2018.
6. Ahovuo-Saloranta A, Rautakorpi U, Borisenko O, et al. Antibiotics for acute maxillary sinusitis in adults. Cochrane Database Syst Rev. 2014;2: CD000243.
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