Practical guideline for management of acute rhinosinusitis in Japan
Introduction
Recently high prevalence of antimicrobial resistant bacteria has made rhinosinusitis refractory resulting in frequent prescription of antimicrobial agents at the usual clinical setting. Despite the high incidence and economical impact of sinusitis, considerable practice variations exist across and within multiple disciplines involved in managing the condition.
This guideline provides evidence-based recommendations on managing acute rhinosinusitis. The targeted patients for the guideline are children aged 15 years or less and adults aged 16 years or above with no symptoms of acute rhinosinusitis 1 month before the onset, those with no craniofacial anomalies, and those with no immunodeficiency. The guideline is not intended to apply to patients with acute exacerbation of chronic sinusitis or those with odontogenic maxillary sinusitis.
Section snippets
Definition of acute rhinosinusitis
Acute rhinosinusitis is defined as symptomatic inflammation of the nose and paranasal sinuses with an acute onset that presents with respiratory symptoms, such as nasal obstruction, rhinorrhea, postnasal discharge, and coughing, accompanied by headaches, cheek pain, and a sensation of facial compression.
Acute rhinosinusitis is defined as inflammation persisting 4 weeks [1], and this definition was also employed in this guideline. Also, the guideline does not apply to the acute exacerbation of
Bacteriology in acute rhinosinusitis
The drug susceptibility of Streptococcus (St.) pneumoniae has been defined on the basis of the minimal inhibitory concentration (MIC) of penicillin G according to the criteria of the National Committee for Clinical Laboratory Standards (NCCLS) revised in 1998 [2]. St. pneumoniae has been classified as follows on the basis of its susceptibility to penicillin G: penicillin susceptible St. pneumoniae (PSSP): MIC ≤ 0.06 μg/mL, penicillin intermediately resistant St. pneumoniae (PISP): MIC = 0.125–1.0
General methods and literature search
In creating this guideline the Japanese Rhinologic Society selected a panel representing the fields of infectious diseases, allergy, otolaryngology-head and neck surgery, nutrition, and medical informatics. Several members in this multidisciplinary panel had significant prior experience in developing clinical practice guideline.
Collection of evidence
In preparing the guideline, clinical questions were prepared regarding (1) the diagnosis, (2) clinical examination, (3) treatments, and (4) complications, and relevant existing literature searches were performed through December 20, 2009.
PubMed, Cochrane Library, and Japana Centro Revuo Medicina Web version 4 were searched as literature database.
The relevant literature published between 2000 and 2009 was reviewed for the search period. Priority was given to systematic reviews of randomized
Classification of and recommendation of evidence-based statements
In preparing this guideline, evidence levels were indicated by the following notational system proposed by the Japan Stroke Society.
Evidence levels were determined as follows: Ia, meta-analysis (with homogeneity) of randomized controlled trials; Ib, at least one randomized controlled trial; IIa, at least one well designed, controlled study without randomization; IIb, at least one well designed, quasi-experimental study; III, at least one well designed, non-experimental descriptive study (e.g.,
Conclusion
This is the position paper for Clinical Practice Guideline for Acute Rhino sinusitis in Children and Adults in Japan. The panel employed scoring systems in line with the severity of clinical symptoms and rhinorrhea/nasal discharge. Recommendations and answers for 9 clinical questions were developed and the treatment algorithm for acute rhinosinusitis was proposed.
Financial disclosure and conflicts of interest
The Japanese Rhinologic Society covered the cost of developing this guideline, including travel expenses of all panel members, in full, and the scholarship of Takahashi Otolaryngological Research Foundation covered the cost of preparing this manuscript in part. The Japanese Rhinologic Society is not supported by any particular organization or business firm, and no funding from business firms, such as pharmaceutical companies, was used for the preparation of these guidelines.
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