2012年美国感染学会急性细菌性鼻窦炎临床指南

This guideline addresses several issues in the management of acute bacterial rhinosinusitis (ABRS), including (1) inability of existing clinical criteria to accurately differentiate bacterial from viral acute rhinosinusitis, leading to excessive and inappropriate antimicrobial therapy; (2) gaps in knowledge and quality evidence regarding empiric antimicrobial therapy for ABRS due to imprecise patient selection criteria; (3) changing prevalence and antimicrobial susceptibility profiles of bacterial isolates associated with ABRS; and (4) impact of the use of conjugated vaccines for Streptococcus pneumoniae on the emergence of nonvaccine serotypes associated with ABRS. An algorithm for subsequent management based on risk assessment for antimicrobial resistance and evolution of clinical responses is offered (Figure 1). This guideline is intended for use by all primary care physicians involved in direct patient care, with particular applicability to patients managed in community or emergency department settings. Continued monitoring of the epidemiology and rigorous investigation of the efficacy and cost-benefit of empiric antimicrobial therapy for suspected ABRS are urgently needed in both children and adults.

Summarized below are the recommendations made in the new guideline for ABRS in children and adults. The panel followed a process used in the development of other Infectious Diseases Society of America (IDSA) guidelines that includes a systematic weighting of the strength of recommendation (eg, ‘‘high, moderate, low, very low’’) and quality of evidence (eg, ‘‘strong, weak’’) using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. A detailed description of the methods, background, and evidence summaries that support each of the recommendations can be found in the full text of this guideline.