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.
References (38)
- et al.
The diagnosis and management of sinusitis: a practice parameter update
J Allergy Clin Immunol
(2005) Acute and chronic bacterial sinusitis
Infect Dis Clin North Am
(2007)- et al.
The first nationwide surveillance of bacterial respiratory pathogens conducted by the Japanese Society of Chemotherapy. Part 1: A general view of antibacterial susceptibility
J Infec Chemother
(2008) - et al.
Staging in rhinosinusitis
Otolaryngol Head Neck Surg
(1997) Diagnosis of sinusitis in children: emphasis on the history and physical examination
J Allergy Clin Immunol
(1992)- et al.
Eradication of pathogens from the nasopharynx after therapy of acute maxillary sinusitis with low- or high dose amoxicillin/clavulanic acid
Antimicrob Agents
(2005) - et al.
A multicenter, randomized, investigator-blinded study of 5- and 10-day gatifloxacin versus 10-day amoxicillin/clavulanate in patients with acute bacterial sinusitis
Clin Ther
(2002) - et al.
Comparison of the effectiveness of levofloxacin and amoxicillin–clavulanate for the treatment of acute sinusitis in adults
Otolaryngol Head Neck Surg
(1999) - et al.
Onset of symptom resolution in adults with acute bacterial rhinosinusitis treated with a single dose of azithromycin extended release compared with 10 days of levofloxacin: a retrospective analysis of a randomized, double-blind, double-dummy trial
Clin Ther
(2007) - et al.
Efficacy and safety of a novel, single-dose azithromycin microsphere formulation versus 10 days of levofloxacin for the treatment of acute bacterial sinusitis in adults
Otolaryngol Head Neck Surg
(2005)
Performance standards for antimicrobial susceptibility testing: eighteenth informational supplement. CLSI document M100-S18
Report of the results of the 2nd national surveillance of clinical isolates from patients with otolaryngological infections
J Jpn Soc Infect Dis Otolaryngol
Report of the results of the 3rd national surveillance of clinical isolates from patients with otolaryngological infections
J Jpn Soc Infect Dis Otolaryngol
Report of the results of the 4th national surveillance of clinical isolates from patients with otolaryngological infections
J Jpn Soc Infect Dis Otolaryngol
Bacteriology of nasal discharge in children
J Jpn Rhinol Soc
Acute community-acquired sinusitis-continuing challenges and current management
Clin Infect Dis
Antimicrobial treatment guidelines for acute bacterial rhinosinusitis
Otolaryngol Head Neck Surg
Problems with rhinosinusitis in children
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Survey of nebulizer therapy for nasal inflammatory diseases in Japan before and during the COVID-19 pandemic
2022, Auris Nasus LarynxCitation Excerpt :Inflammatory nasal and paranasal sinus diseases, such as rhinosinusitis and allergic rhinitis, are common in daily clinical practice. Clinical treatment guidelines for acute rhinosinusitis have been published in Japan [1]; these guidelines recommend enlarging the natural opening of the paranasal sinuses before using a nebulizer for mild cases. Nebulizer therapy has become a well-known treatment option throughout Japan and has been covered by public health insurance since 1958.
Features predicting treatment failure in pediatric acute otitis media
2021, Journal of Infection and ChemotherapyCitation Excerpt :Amoxicillin (AMPC) is recommended as the first choice of drug for the treatment of AOM and it has shown beneficial efficacy in randomized, double-blind, placebo-controlled studies [6–9]. This treatment strategy is similar to the recommended treatment for acute rhinosinusitis [10–15]. It is estimated, however, that up to one-third of children with AOM present refractory and/or recurrent clinical courses [1].
Consensus guidance of nebulizer therapy for acute rhinosinusitis
2020, Auris Nasus LarynxCitation Excerpt :Acute rhinosinusitis is a common upper respiratory tract infection in clinical practice and is defined as symptomatic inflammation of the nose and paranasal sinus persisting 4 weeks with an acute onset that present with respiratory symptoms, such as nasal obstruction, rhinorrhea, post nasal discharge, and coughing, accompanied by headaches, cheek pain, and a sensation of facial compression. In Japan, the practical guideline for management of acute rhinosinusitis was published in 2010 and recommended inhalation antimicrobial therapy denominated nebulizer therapy (inhalation therapy, aerosol therapy) after widening the middle nasal meatus [1,2]. However, there are a limited number of studies on the standard procedures for nebulizer therapy (inhalation therapy, aerosol therapy) and on the assessment of its efficacy for acute rhinosinusitis.
Past, present and future of macrolide therapy for chronic rhinosinusitis in Japan
2016, Auris Nasus LarynxCitation Excerpt :Acute exacerbation: The 14-membered macrolides are unlikely to become the first-choice antibiotics for treating acute rhinosinusitis or acute exacerbation of CRS in Japan, because the major pathogens associated with these diseases, Streptococcus pneumoniae and Haemophilus influenzae, have become highly resistant to EM, CAM, and RXM. In cases of acute exacerbation of CRS during macrolide therapy, amoxicillin or cephem antibiotics such as cefditoren-pivoxil, cefcapene-pivoxil, and cefteram-pivoxil are recommended as the first-line therapy, according to the practical guideline for the management of acute rhinosinusitis in Japan [47]. Bacterial culture and drug susceptibility testing are recommended to select the appropriate antimicrobials for treating acute exacerbation.
Effectiveness of keigairengyoto in patients with chronic rhinosinusitis after endoscopic sinus surgery
2023, Traditional and Kampo MedicineCarbapenem-nonsusceptible haemophilus influenzae with penicillin-binding protein 3 containing an amino acid insertion
2018, Antimicrobial Agents and Chemotherapy