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Acute Bacterial Sinusitis (Resistance Risk (Age <2 or >65,…
Acute Bacterial Sinusitis
Etiology
Bugs
"Usual Three"
H. flu
+
M. cat
(32%, 9%)
Beta-lactamase production becoming more common
S. pneumo
(33%)
PRSP becoming more common
Staph aureus
(10%)
Implicated in chronic/recurrent cases
Oral anaerobes
Implicated in dental infections and chronic ABS
Classifications
Resistance Risk
Age <2 or >65
Hospitalization within last 5 days
Prior antibiotics within last month
Comorbities
Immunocompromised
Treatment
Resistance risk factors?
Yes
Duration of therapy: 7-10 days
Choose second-line agent
amoxicillin/clavulanate 2000/125 mg PO BID [
covers Staph + anaerobes
]
doxycycline 100 mg PO BID [
S. pneumo resistance
]
levofloxacin 500-750 mg PO qd
moxifloxacin 400 mg PO qd [
anaerobic coverage; better vs. Gram+
]
NO GOOD
: Bactrim, macrolides, and oral cephs due to poor activity vs. PRSP
DB
: cefpodoxime + clindamycin?
No
Choose first-line agent
amoxicillin/clavulanate 500/125 mg PO TID
amoxicillin/clavulanate 875/125 mg PO BID
Duration of therapy: 5-7 days
Monitoring
No improvement or worsening after 3-5 days?
Broaden coverage or switch classes