Journal Reading: IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults

7/24/2019 Journal Reading: IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults

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JURNAL READING

Kepaniteraan Klinik

Departemen Telinga Hidung Tenggorokan Kepala-LeherRSAD Gatot Soe!roto

IDSA "lini#al ra#ti#e Guideline $or A#ute%a#terial Rhino&inu&iti& in "hildren and

Adult&Anthon' () "ho*+, i#hael S) %enninger+. It/hak %rook+0 Jan L)%ro/ek+1+2 Ellie J) ") Gold&tein+3+4 Lauri A) Hi#k&+5 George A) anke'+6it#hel Sele/ni#k+,7 Gregor' 8olturo+,, Ellen R) (ald+,. and Thoma& )9ile Jr,0+,1

Di!im!ing oleh: dr) Khairan Irman&'ah+ Sp)THT-KL+ )Ke&Dipre&enta&ikan ;leh:

Gandung rako&orathita Amanda


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Anatom' o$ Na&al


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Anatom' o$ Sinu&e&


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Introdu#tion

Term rhino&inu&iti& i& u&edinter#hangea!l' *ith &inu&iti&)

Na&al mu#o&a i& #ontiguou& *ith thato$ the parana&al &inu&e&+ an'in


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"ont>d

A#ute rhino&inu&iti& i& de?ned a& anin


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"ont>d

Anti!ioti#& *ere preri!ed $or 5,@o$ adult& *ith a#ute rhino&inu&iti&,4+ ,5B+ de&pite the $a#t that

approCimatel' 47@ o$ patient&impro=e &pontaneou&l' in pla#e!o

Thu&+ o=erpreription o$ anti!ioti#&

i& a maor #on#ern in themanagement o$ a#ute rhino&inu&iti&+largel' due to the di#ult' in

diFerentiating A%RS $rom a =iral URI


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I) (hi#h "lini#al re&entation& %e&t Identi$'atient& (ith

A#ute %a#terial 8er&u& 8iral Rhino&inu&iti&

;n&et *ith per&i&tent &'mptom& or&ign& #ompati!le *ith a#uterhino&inu&iti&+ la&ting $or ,7 da'&

*ithout an' e=iden#e o$ #lini#alimpro=ement &trong+ lo*-moderate

;n&et *ith &e=ere &'mptom& or &ign&

o$ high $e=er 06" ,7.9B andpurulent na&al diharge or $a#ialpain la&ting $or at lea&t 01#on&e#uti=e da'& at the !eginning o$

illne&& &trong+ lo*-moderate or


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"ont>d

;n&et *ith *or&ening &'mptom& or&ign& #hara#teri/ed !' the ne* on&eto$ $e=er+ heada#he+ or in#rea&e in

na&al diharge $ollo*ing a t'pi#al=iral URI that la&ted 23 da'& and*ere initiall' impro=ing MMdou!le-

&i#kening>> &trong+ lo*-moderate)


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"on=entional


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II) (hen Should Empiri# Antimi#ro!ial Therap' %eInitiated

in atient& (ith Sign& and S'mptom& Sugge&ti=e o$A%RS

It i& re#ommended that empiri#antimi#ro!ial therap' !e initiated a&&oon a& the #lini#al diagno&i& o$ A%RS

i& e&ta!li&hed a& de?ned inre#ommendation , &trong+moderate)


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III) Should AmoCi#illin 8er&u& AmoCi#illin-"la=ulanate %eU&ed $or Initial Empiri# Antimi#ro!ial Therap' o$ A%RS in

"hildren

AmoCi#illin-#la=ulanate rather thanamoCi#illin alone i& re#ommended a&empiri# antimi#ro!ial therap' $or

A%RS in #hildren &trong+ moderate)

I8 Sh ld A i illi 8 A i illi "l l t


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I8) Should AmoCi#illin 8er&u& AmoCi#illin-"la=ulanate%e

U&ed $or Initial Empiri# Antimi#ro!ial Therap' o$A%RS in

Adult& AmoCi#illin-#la=ulanate rather than

amoCi#illin alone i& re#ommended a&empiri# antimi#ro!ial therap' $or

A%RS in adult& *eak+ lo*)


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8) (hen I& High-Do&e AmoCi#illin-"la=ulanateRe#ommended During Initial Empiri# Antimi#ro!ial

Therap'$or A%RS in "hildren or Adult&

High-do&e amoCi#illin-#la=ulanate i&re#ommended $or #hildren and adult&*ith geographi# region& o$ in=a&i=e

NS S. pneumoniae+ tho&e *ith&e=ere in$e#tion+ attendan#e atda'#are+ age . or 32 'ear&+ re#ent

ho&pitali/ation+ anti!ioti# u&e *ithinthe pa&t month+ or *ho areimmuno#ompromi&ed *eak+

moderate)


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8I) Should a Re&pirator' 9luorouinolone =& !eta La#tamAgent %e U&ed a& 9ir&t-line Agent& $or the Initial Empiri#

Antimi#ro!ial Therap' o$ A%RS

A !eta la#tam agent amoCi#illin-#la=ulanate rather than a re&pirator'


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) +a a#rolide+ TOSP+ DoC'#'#line+ or a Se#ond- or

Third-Generation ;ral "ephalo&porin %e U&ed a& Se#ond-

lineTherap' $or A%RS in "hildren or Adult&

a#rolide& #larithrom'#in anda/ithrom'#in are not re#ommended

$or empiri# therap' due to high rate&o$ re&i&tan#e among S. pneumoniae07@ &trong+ moderate)

TOSP i& not re#ommended $orempiri# therap' due to high rate& o$re&i&tan#e among !oth S)pneumoniae and H) in


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"ont>d

Se#ond- and third-generation oral#ephalo&porin& are no longerre#ommended $or empiri#

monotherap' o$ A%RS) "om!inationtherap' a third-generation oral#ephalo&porin plu& #lindam'#in ma'

!e u&ed a& &e#ond-line therap' $or#hildren *ith nont'pe I peni#illinallerg' or tho&e *ith high endemi#

rate& o$ NS S) pneumoniae *eak+

8III (hi#h Antimi#ro!ial Regimen& Are


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8III) (hi#h Antimi#ro!ial Regimen& AreRe#ommended $or

the Empiri# Treatment o$ A%RS in Adult& and"hildren (ith

a Hi&tor' o$ eni#illin Allerg' Either doC'#'#line not &uita!le $or

#hildren or a re&pirator'


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"ont>d

Le=o


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IP) Should "o=erage $or S. aureus E&pe#iall' RSA%e

ro=ided Routinel' During Initial Empiri# Therap' o$A%RS

Although S) aureu& in#luding RSAi& a potential pathogen in A%RS+!a&ed on #urrent data+ routine

antimi#ro!ial #o=erage $or S. aureusor RSA during initial empiri#therap' o$ A%RS i& not re#ommended

&trong+ moderate)

P Should Empiri# Antimi#ro!ial Therap' $or


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P) Should Empiri# Antimi#ro!ial Therap' $orA%RS %e

Admini&tered $or 24 Da'& 8er&u& ,7,1

Da'& The re#ommended duration o$

therap' $or un#ompli#ated A%RS inadult& i& 24 da'& *eak+ lo*-

moderate)

In #hildren *ith A%RS+ the longertreatment duration o$ ,7,1 da'& i&

&till re#ommended *eak+ lo*-moderate)


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PI) I& Saline Irrigation o$ the Na&al Sinu&e& o$%ene?t a&

Adun#ti=e Therap' in atient& (ith A%RS

Intrana&al &aline irrigation& *itheither ph'&iologi# or h'pertoni#&aline are re#ommended a& an

adun#ti=e treatment in adult& *ithA%RS *eak+ lo*-moderate)

PII Are Intrana&al "orti#o&teroid&


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PII) Are Intrana&al "orti#o&teroid&Re#ommended a& an

Adun#t to Antimi#ro!ial Therap' in atient&

(ith A%RS IN"S& are re#ommended a& an

adun#t to anti!ioti#& in the empiri#treatment o$ A%RS+ primaril' in

patient& *ith a hi&tor' o$ allergi#rhiniti& *eak+ moderate)

Sh ld i l ; l


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PIII) Should Topi#al or ;ral De#onge&tant& orAntihi&tamine&

%e U&ed a& Adun#ti=e Therap' in atient& (ithA%RS

Neither topi#al nor oralde#onge&tant& andOor antihi&tamine&are re#ommended a& adun#ti=e

treatment in patient& *ith A%RS&trong+ lo*-moderate)

PI8 Ho* Long Should Initial Empiri# Antimi#ro!ial


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PI8) Ho* Long Should Initial Empiri# Antimi#ro!ialTherap'

in the A!&en#e o$ "lini#al Impro=ement %e"ontinued %e$ore

"on&idering Alternati=e anagement Strategie& An alternati=e management &trateg'

i& re#ommended i$ &'mptom& *or&ena$ter 154. hour& o$ initial empiri#

antimi#ro!ial therap'+ or $ail toimpro=e de&pite 02 da'& o$ initialempiri# antimi#ro!ial therap'

&trong+ moderate)

Strateg' in


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Strateg' inatient& (ho "lini#all' (or&en De&pite 4. Hour& or

9ail toImpro=e A$ter 02 Da'& o$ Initial Empiri#

Antimi#ro!ialTherap' (ith a 9ir&t-line Regimen atient& *ho #lini#all' *or&en

de&pite 4. hour& or $ail to impro=ea$ter 02 da'& o$ empiri#

antimi#ro!ial therap' *ith a ?r&t-lineagent &hould !e e=aluated $or thepo&&i!ilit' o$ re&i&tant pathogen&+ a

nonin$e#tiou& etiolog'+ &tru#turala!normalit'+ or other #au&e& $ortreatment $ailure &trong+ lo*

P8I In anaging the atient (ith A%RS (ho Ha& 9ailed


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P8I) In anaging the atient (ith A%RS (ho Ha& 9ailedto Re&pond to Empiri# Treatment (ith %oth 9ir&t-line

and Se#ond-line Agent&+ It I& Important to ;!tain "ulture& toDo#ument (hether There I& er&i&tent %a#terial In$e#tion and

(hether Re&i&tant athogen& Are re&ent) In Su#h atient&+ Should

"ulture& %e ;!tained !' Sinu& un#ture or Endoop'+ or Are"ulture& o$ Na&ophar'ngeal S*a!& Su#ient

It i& re#ommended that #ulture& !eo!tained !' dire#t &inu& a&pirationrather than !' na&ophar'ngeal&*a!& in patient& *ith &u&pe#ted&inu& in$e#tion *ho ha=e $ailed to

re&pond to empiri#antimi#ro!ialtherap' &trong+ moderate)


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Endoopi#all' guided #ulture& o$ themiddle meatu& ma' !e #on&idered a&

an alternati=e in adult& !ut theirrelia!ilit' in #hildren ha& not !eene&ta!li&hed *eak+ moderate)

Na&ophar'ngeal #ulture& areunrelia!le and are not re#ommended$or the mi#ro!iologi# diagno&i& o$

A%RS &trong+ high)

atient&


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atient&(ith Se=ere A%RS (ho Are Su&pe#ted to Ha=e

Suppurati=e"ompli#ation& Su#h a& ;r!ital or Intra#ranial

ECten&ion o$In$e#tion In patient& *ith A%RS &u&pe#ted to

ha=e &uppurati=e #ompli#ation&+o!taining aCial and #oronal =ie*& o$

#ontra&t enhan#ed "T rather thanRI i& re#ommended $or lo#ali/ationo$ in$e#tion and to guide $urther

treatment *eak+ lo*)


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P8III) (hen I& Re$erral to a Spe#iali&t Indi#ated in aatient

(ith re&umed A%RS

atient& *ho are &eriou&l' ill+immuno#ompromi&ed+ #ontinue todeteriorate #lini#all' de&pite

eCtended #our&e& o$ antimi#ro!ialtherap'+ or ha=e re#urrent o$ a#uterhino&inu&iti& *ith #learing !et*een

epi&ode& &hould !e re$erred to a&pe#iali&t &u#h a& anotolar'ngologi&t+ in$e#tiou& di&ea&e

&pe#iali&t+ or allergi&t $or


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A%RS Algorithma


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A%RS Algorithma

Documents

Journal Reading: IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults