How is acute sinusitis treated?

An otolaryngologist is required to treat acute purulent sinusitis. The main objectives of purulent sinusitis therapy are:

• eradication of the bacterial pathogen;
• prevention of the transition of the inflammatory process from acute to chronic;
• prevention of complications;
• alleviation of clinical manifestations of the disease;
• removal of exudate and sanitation of sinuses.

Non-drug treatment of acute sinusitis

There is no special non-drug treatment for acute sinusitis, both catarrhal and purulent. The diet is normal. The regimen is extended, except for pansinusitis, when bed rest is prescribed for 5-7 days.

Drug treatment of acute sinusitis

First of all, it is necessary to ensure drainage from the paranasal sinuses. For this, especially in case of catarrhal sinusitis, intranasal decongestants are used. In addition, local antibacterial or antiseptic drugs are indicated for catarrhal sinusitis. For this purpose, fusafungine (bioparox) in a spray is used in children over 2.5 years old, 2-4 sprays 4 times a day in each half of the nose for 5-7 days, or hexetidine (hexoral) in a spray is used, 1-2 sprays in each half of the nose 3 times a day, also for 5-7 days. Children under 2.5 years old are prescribed hexoral in drops, 1-2 drops 3-4 times a day in each half of the nose for 7-10 days.

Along with local antibacterial drugs, mucoregulators or at least mucolytics such as acetylcysteine are indicated for catarrhal sinusitis. Carbocysteine (fluditek, bron-catarrhal mucopront, mucodin, etc.) is a mucoregulator. Carbocysteine changes the quantitative ratio between acidic and neutral sialomucins, bringing it closer to normal, and reduces mucus production. Its effect is manifested at all levels of the respiratory tract, both at the level of the mucous membrane of the bronchial tree and at the level of the mucous membranes of the nasopharynx and paranasal sinuses. Acetylcysteine (ACC, N-AC-ratiopharm, fluimucil) is widely used for catarrhal and purulent sinusitis due to its pronounced mucolytic effect to improve the outflow of the contents of the nasal sinuses.

Mucoregulators and mucolytics are used according to the following schemes:

• Acetylcysteine:
  • up to 2 years: 100 mg 2 times a day, orally;
  • from 2 to 6 years: 100 mg 3 times a day, orally;
  • over 6 years: 200 mg 3 times a day or ACC Long 1 time at night, orally.
• Carbocisteine:
  • up to 2 years: 2% syrup 1 teaspoon (5 ml) 1 time per day or 1/2 teaspoon 2 times per day;
  • from 2 to 5 years: 2% syrup, 1 teaspoon 2 times a day;
  • over 5 years: 2% syrup, 1 teaspoon 3 times a day.

For catarrhal and catarrhal-purulent acute sinusitis, adaptogens are prescribed, in particular Sinupret, which contains gentian root, primrose flowers, sorrel, elder flowers and verbena. It is prescribed to children over 6 years old. sublingually, 1 tablet 2 times a day for 1 month.

In case of catarrhal and catarrhal-purulent acute sinusitis, the herbal medicine Sinupret is prescribed, which contains gentian root, primrose flowers, sorrel grass, elder flowers and verbena grass. Sinupret has a complex secretolytic, secretomotor, expectorant, anti-inflammatory, antiviral and antioxidant effect, which allows to influence all links in the development of both acute and chronic rhinosinusitis, as well as to prescribe Sinupret for preventive purposes.

Sinupret in the form of drops for oral administration is conveniently prescribed to children from 2 to 6 years old, 15 drops 3 times a day, children from 6 years and older, 25 drops or 1 dragee 3 times a day.

The absence of a clinical effect from the therapy administered within 5 days and/or in the presence of pronounced or increasing radiographic or ultrasound changes in the paranasal sinus cavities serves as an indication for the administration of systemic antibiotics.

When choosing antibiotics, special attention is paid to the patient's age and premorbid background, since the choice depends on the etiology and risk of complications. For children in the first six months of life, drugs are prescribed parenterally; for children older than the first six months, the method of antibiotic administration is determined depending on the severity of the process.

Choice of systemic antibiotics for acute purulent sinusitis in children

Disease	Possible causative agent	Drug of choice	Alternative therapy
Acute purulent ethmoiditis	Staphylococci Escherichia coli Klebsiella Haemophilus influenzae	Oxacillin in combination with aminoglycosides Amoxicillin + clavulanic acid Cefuroxime axetil or cefuroxime sodium	Ceftriaxone Cefotaxime Vancomycin
Acute purulent sinusitis, frontal sinusitis, sphenoiditis	Pneumococci Haemophilus influenzae Moraxella catarrhalis	Amoxicillin Amoxicillin + clavulanic acid Cefuroxime axetil	Ceftriaxone Cefotaxime Lincosamides
Acute pansinusitis	Pneumococci Haemophilus influenzae Staphylococci Enterobacteria	Ceftriaxone Cefotaxime	Cefepime Carbapenems Vancomycin

Doses of antibiotics used in acute purulent sinusitis, their routes of administration and frequency of administration

Antibiotic	Doses	Routes of administration	Frequency of administration
Penicillin and its derivatives
Amoxicillin	For children under 12 years old 25-50 mg/kg For children over 12 years old 0.25-0.5 g every 8 hours	Orally	3 times a day
Amoxicillin + clavulanic acid	For children under 12 years of age 20-40 mg/kg (for amoxicillin) For children over 12 years of age with mild pneumonia, 0.625 g every 8 hours or 1 g every 12.	Orally	2-3 times 8 days
Amoxicillin clavulanic acid	For children under 12 years of age 30 mg/kg (for amoxicillin) For children over 12 years old 1.2 g every 8 or 6 hours	Intravenously	2-3 times a day
Oxacillin	For children under 12 years 40 mg/kg For children over 12 years old 4-6 g per day	Intravenous, intramuscular	4 times a day
1st and 2nd generation cephalosporins
Cefuroxime sodium	For children under 12 years old 50-100 mg/kg For children over 12 years old 0.75-1.5 g every 8 hours	Intravenous, intramuscular	3 times a day
Cefuroxime accessetype	For children under 12 years old 20-30 mg/kg For children over 12 years old 0.25-0.5 g every 12 hours	Orally	2 times a day
3rd generation cephalosporins
Cefotaxime	For children under 12 years old 50-100 mg/kg For children over 12 years old 2 g every 8 hours	Intravenous, intramuscular	3 times a day
Ceftriaxone	For children under 12 years 50-75 mg/kg For children over 12 years old 1-2 g	Intramuscular, intravenous	1 time per day
4th generation cephalosporins
Cefepime	For children under 12 years old 100-150 mg/kg For children over 12 years old 1-2 g every 12 hours	Intravenously	3 times a day
Carbapenems
Imipenem	For children under 12 years 30-60 mg/kg For children over 12 years old 0.5 g every 6 hours	Intramuscular, intravenous	4 times a day
Meropenem	For children under 12 years 30-60 mg/kg For children over 12 years old 1 g every 8 hours	Intramuscular, intravenous	3 times a day
Glycopeptides
Vancomycin	For children under 12 years 40 mg/kg For children over 12 years old 1 g every 12 hours	Intramuscular, intravenous	3-4 times a day
Aminoglycosides
Gentamicin	5 mg/kg	Intravenous, intramuscular	2 times a day
Amikacin	15-30 mg/kg	Intramuscular, intravenous	2 times a day
Netilmicin	5 mg/kg	Intramuscular, intravenous	2 times a day
Lincosamides
Lincomycin	For children under 12 years 60 mg/kg For children over 12 years old 1-1.5 g every 12 hours	Orally	2-3 times a day
Lincomycin	For children under 12 years 30-50 mg/kg For children over 12 years old 0.5-0.6 g every 12 hours	Intramuscular, intravenous	2 times a day
Clindamycin	For children under 12 years 15 mg/kg For children over 12 years old 0.3 g every 8 hours	Intramuscular, intravenous	3 times a day

The duration of antibacterial therapy is on average 7-10 days.

One of the problems with the use of traditional tablet forms of amoxicillin/clavulanate is the safety profile. Thus, according to one study, the frequency of such an adverse drug reaction as diarrhea when taking it can reach 24%. A new form of amoxicillin/clavulanate, Flemoklav Solutab (dispersible tablets), which has recently appeared on the Russian market, is characterized by a higher and more predictable absorption of clavulanic acid in the intestine. From a clinical point of view, this means that Flemoklav Solutab provides a more stable and more predictable therapeutic effect and helps reduce the risk of adverse drug reactions from the gastrointestinal tract. primarily diarrhea. The innovative Solutab technology allows the active substance to be enclosed in microspheres, from which the tablet is formed. Each microsphere consists of an acid-resistant filler, which protects its contents from the action of gastric juice. The release of active components begins at an alkaline pH in the upper intestine, i.e. in the zone of maximum absorption.

A significant reduction in the incidence of adverse drug reactions (especially diarrhea) when using Flemoklav Solutab in children has been confirmed by a number of Russian clinical studies. In children, during therapy with Flemoklav SolutabA more rapid resolution of clinical symptoms of sinusitis was observed compared with the original amoxicillin/clavulanate drug.

In addition to systemic antibiotics, intranasal decongestants are prescribed for acute purulent sinusitis.

Surgical treatment of acute sinusitis

In acute purulent processes, punctures of the maxillary sinuses, trepanopunctures of the frontal sinuses with the introduction of antibiotics are indicated; in case of complications, opening of the cells of the ethmoid labyrinth, up to radical operations.

Indications for consultation with other specialists

Treatment of purulent acute sinusitis is carried out in parallel by an otolaryngologist and a pediatrician.

Indications for hospitalization

In case of catarrhal acute sinusitis, there is no need for hospitalization. In case of acute purulent ethmoiditis or maxillary ethmoiditis in an infant and a child under 2-2.5 years of age, hospitalization is indicated due to the high risk of intracranial and general (sepsis) complications, the need for parenteral administration of antibiotics and endoscopic interventions. In case of acute purulent sinusitis, frontal sinusitis, the need for hospitalization is determined in each individual case and depends on the severity of the process and aggravating premorbid factors. Acute pansinusitis is a reason for mandatory hospitalization.

Forecast

Generally favorable if treatment is started in a timely manner.

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