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  #1  
Old 09-06-2012
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Question Sinusitis Treatment

A 36-year-old female complains of 5 days of fever, nasal congestion, sinus pressure, and postnasal drip. On examination, nasal discharge is yellow and the posterior pharynx is slightly erythematous. Tapping over the maxillary sinuses elicits mild pain. Which of the following is the most appropriate treatment for this patient?

(A) treatment of symptoms (analgesics,antipyretics, decongestants)
(B) 7-day course of amoxicillin
(C) 10-day course of amoxicillin clavulanic acid
(D) 14-day course of clarithromycin

Source -Not from any of the Qbanks
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  #2  
Old 09-06-2012
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Would go with B
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c.) 10 day amoxicillin + clavulanic acid for sinusitis
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(C) 10-day course of amoxicillin clavulanic acid
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Old 09-07-2012
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yes C.........
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Old 09-07-2012
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Option A. Symptomatic treatment.
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Old 09-07-2012
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B...............
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I would give B
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Old 09-07-2012
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I go for B, you start simple and then move forward with more complex drugs in case it is refractory.

There is no proven benefit or difference between Amoxicillin and Augmentin in the treatment of both Otitis media and Sinusitis, seeing that this is not viral anymore I would go for B and in case it doesnt work then for C

Would also give nasal decongestants because the only way to really cure sinusitis is by draining all that crap that is inside (trust me i suffer from sinusitis)
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Answer (A) The Clinical Practice Guidelines of the American College of Physicians (endorsed by Centers for Disease Control [CDC], American Academy of Family Physicians, and the Infectious Diseases Society of America) state that most cases of acute sinusitis in the ambulatory setting are due to viral infection and do not require antibiotic treatment or radiography.Therapy should be targeted toward symptoms and often include decongestants, antipyretics, and analgesics. Antibiotic treatment should be reserved for patients who have symptoms that persist or worsen (generally for morethan 7 days).
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mmm so 7 days is the cut-off damn, somewhere i read it was 5, ok then! thats why i chose B damn
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Quote:
Originally Posted by XpaezX View Post
mmm so 7 days is the cut-off damn, somewhere i read it was 5, ok then! thats why i chose B damn
I found this in emedicine http://emedicine.medscape.com/article/232670-treatment
Quote:
Recommendations for antimicrobial therapy
Ahovuo-Saloranta et al, in a 2008 Cochrane Review meta-analysis of 57 studies, concluded that antibiotics yield a small treatment effect in a primary care setting in patients with uncomplicated sinusitis whose symptoms have lasted more than 7 days.[37] However, another meta-analysis found no treatment effect of antibiotics, even in patients whose symptoms had persisted for more than 10 days
So when will be prescribe antibiotics after 7 days or 10 days ?, i could not find exact management anywhere
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Quote:
Originally Posted by step_enhancer View Post
I found this in emedicine http://emedicine.medscape.com/article/232670-treatment


So when will be prescribe antibiotics after 7 days or 10 days ?, i could not find exact management anywhere
I would follow the guidelines you posted after 7 days give amoxicillin WITHOUT clavulanate (in a healthy patient without any crazy thing)
If refractory you then can give Augmentin or any other stronger medication

IN MTB step 2 CK on pague 14 and 15 they say you give antibiotics plus decongestant.
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