How is acute sinusitis treated?

In the treatment of acute purulent sinusitis necessarily involved a doctor-otolaryngologist. The main objectives of purulent sinusitis therapy:

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

Non-drug treatment of acute sinusitis

There is no special non-pharmacological treatment for acute sinusitis, both catarrhal and purulent. Diet is normal. Advanced mode, except for pansinusita, when appoint bed rest for 5-7 days.

Medical treatment of acute sinusitis

It is necessary first of all to provide an outflow from the paranasal sinuses, For this, especially with catarrhal sinusitis, intranasal decon geggants are used. In addition, catarrhal sinusitis shows local antibacterial or antiseptic drugs. For this purpose, fusafungin (bioparox) is used in children over 2.5 years in a spray of 2-4 injections 4 times a day in each half of the nose for 5-7 days or hexethidine (hexoral) in a spray of 1-2 injections per each half of the nose 3 times a day also for 5-7 days. Children under the age of 2.5 years 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, catarrhal sinusitis shows mucoregulators or at least mucolytics such as acetylcysteine. Mucoregulators include carbocysteine (fljuditek, bron-qatar mukoprint, mucodin, etc.). Carbocysteine changes the quantitative ratio between acidic and neutral sialomucins. Bringing it closer to normal, and reduces the production of mucus. In this case, 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, the paranasal sinuses. Acetylcysteine (ATSTS, N-AC-ratiopharm, fluimitsil) due to pronounced mucolytic action is widely used in catarrhal and purulent sinusitis to improve the outflow of the contents of the sinuses of the nose.

Mukoregulators and mucolytics are used according to the following schemes:

• Acetylcysteine:
  • up to 2 years: 100 mg2 a day, inside;
  • from 2 to 6 years: 100 mg 3 times a day, inside;
  • over 6 years: 200 mg 3 times a day or ACTS Long 1 time per night, inside.
• Carbocysteine:
  • up to 2 years: 2% syrup for 1 teaspoonful (5 ml) once a day or 1/2 teaspoon 2 times a day;
  • from 2 to 5 years: 2% syrup 1 teaspoonful 2 times a day;
  • over 5 years: 2% syrup 1 teaspoonful 3 times a day.

With catarrhal and catarrhal-purulent acute sinusitis, adaptogens are prescribed, in particular sinupret, which contains the root of gentian, primrose flowers, sorrel, elderberry flowers and verbena. Assign it to children over 6 years. Sublingually, 1 tablet 2 times a day for 1 month.

With catarrhal and catarrhal-purulent acute sinusitis, a medicinal herbal preparation Sinupret is prescribed, which contains the root of the gentian. Flowers of primrose, grass sorrel, elder flowers and verbena grass. Sinupret has a complex secretolitic, secretory-motor, expectorant, anti-inflammatory, antiviral and antioxidant action, which allows to influence all stages of development of both acute and chronic rhinosinusitis, and also prescribe Sinupret for preventive purposes.

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

The lack of clinical effect of the therapy for 5 days and / or in the presence of pronounced or increasing radiological or ultrasound changes in the cavities of the paranasal sinuses serves as an indication for the administration of systemic antibiotics.

When choosing antibiotics, special attention is paid to the age of the patient and his premorbid background, since the choice depends on the etiology and the risk of complications. Children of the first half of life drugs prescribed parenterally, children older than the first half of the way the antibiotic is administered, depending on the severity of the process.

Selection of systemic antibiotics for acute purulent sinusitis in children

Disease	Possible causative agent	The drug of choice	Alternative Therapy
Acute purulent etmoiditis	Staphylococcus E. Coli Klebsiella Hemophilus influenzae	Oxacillin in combination with aminoglycosides Amoxicillin + clavulanic acid Cefuroxime axetil or cefuroxime sodium	Ceftriaxone Cefotaxime Vancomycin
Acute purulent sinusitis, frontal sphenoiditis	Pneumococci Hemophilus rod moraxella catarrhis	Amoxicillin Amoxicillin + clavulanic acid Cefuroxime Axetil	Ceftriaxone Cefotaxime Lincosamides
Acute boardinusitis	Pneumococcus Hemophilus influenzae Staphylococci Enterobacteria	Ceftriaxone Cefotaxime	Cefepim Carbapenems Vancomycin

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

Antibiotic	Doses	Routes of administration	Multiplicity of the introduction
Penicillin and its derivatives
Amoxicillin	For children under 12 years 25-50 mg / kg For children over 12 years of age, 0.25-0.5 g every 8 hours	Orally	3 times a day
Amoxicillin + clavulanic acid	For children under 12 years 20-40 mg / kg (for amoxicillin) For children older than 12 years 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 30 mg / kg (for amoxicillin) For children over 12 years of age, 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 4-6 grams per day	Intravenous, intramuscular	4 times a day
Cephalosporins of the 1st and 2nd generations
Cefuroxime sodium	For children under 12 years of age 50-100 mg / kg For children over 12 years of age 0.75-1.5 g every 8 hours	Intravenous, intramuscular	3 times a day
Cefuroxime aksetip	For children under 12 years 20-30 mg / kg For children over 12 years of age, 0.25-0.5 g every 12 hours	Orally	2 times a day
Third-generation cephalosporins
Cefotaxime	For children under 12 years of age 50-100 mg / kg For children over 12 years, 2 g every 8 hours	Intravenous, intramuscular	3 times a day
Ceftriaxone	For children under 12 years of age 50-75 mg / kg For children over 12 years of age 1-2 g	Intramuscularly, intravenously	1 time per day
Cephalosporins of the 4th generation
Cefepim	For children under 12 years of age 100-150 mg / kg For children over 12 years 1-2 g every 12 h	Intravenously	3 times a day
Carbapenems
Imipenem	For children under 12 years 30-60 mg / kg For children over 12 years, 0.5 g every 6 hours	Intramuscularly, intravenously	4 times a day
Meropenem	For children under 12 years 30-60 mg / kg For children over 12 years of age, 1 g every 8 hours	Intramuscularly, intravenously	3 times a day
Glycopeptides
Vancomycin	For children under 12 years 40 mg / kg For children over 12 years of age, 1 g every 12 hours	Intramuscularly, intravenously	3-4 times a day
Aminoglycosides
Gentamicin	5 mg / kg	Intravenous, intramuscular	2 times a day
Amikacin	15-30 mg / kg	Intramuscularly, intravenously	2 times a day
Nethylmycin	5 mg / kg	Intramuscularly, intravenously	2 times a day
Lincosamides
Lincomycin	For children under 12 years 60 mg / kg For children over 12 years of age, 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, 0.5-0.6 g every 12 hours	Intramuscularly, intravenously	2 times a day
Clindamycin	For children under 12 years 15 mg / kg For children over 12 years of age 0.3 g every 8 hours	Intramuscularly, intravenously	3 times a day

The duration of antibiotic therapy averages 7-10 days.

One of the problems with the use of traditional tablet forms of amoxicillin / clavulanate is the safety profile. So, according to one of the studies, the frequency of such an undesirable drug reaction. As a diarrhea, at its or his reception can reach 24%. More recently, a new form of amoxicillin / clavulanate release appeared on the Russian market. Flemoclav Solutab (dispersible tablets) is characterized by a higher and predictable absorption of clavulanic acid in the intestine. From a clinical point of view, this means that Flemoclav Solutab provides a more stable and easier predictable therapeutic effect and helps reduce the risk of developing unwanted drug reactions from the gastrointestinal tract. Primarily diarrhea Innovative technology Solutab allows you to conclude the active substance in the microspheres, from which the tablet is formed. Each microsphere consists of an acid-fast filler, which protects its contents from the action of gastric juice. The release of active components begins with an alkaline pH value in the upper intestine, i.e. In the zone of maximum absorption.

A significant reduction in the frequency of unwanted drug reactions (especially diarrhea) with the use of Flemoklava Solutab in children has been confirmed by a number of Russian clinical trials. At children on a background of therapy Flemoklavom SolutabThere was a faster resolution of the clinical symptoms of sinusitis compared to the original amoxicillin / clavulanate drug.

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

Surgical treatment of acute sinusitis

In acute purulent processes are shown punctures of the maxillary sinuses, trepanopunctures of the frontal sinuses with the introduction of antibiotics, in case of complications, the cells of the latticed labyrinth are opened, up to radical operations.

Indications for consultation of other specialists

Treatment of purulent acute sinusitis is performed in parallel by an otolaryngologist and pediatrician.

Indications for hospitalization

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

Forecast

It is generally favorable with timely treatment.

[1], [2], [3], [4], [5], [6],