PDF(Pubmed)
Abstract：
OBJECTIVE: To provide a clinical summary of the Canadian clinical practice guidelines for acute bacterial rhinosinusitis (ABRS) that includes relevant considerations for family physicians.
METHODS: Guideline authors performed a systematic literature search and drafted recommendations. Recommendations received both strength of evidence and strength of recommendation ratings. Input from external content experts was sought, as was endorsement from Canadian medical societies (Association of Medical Microbiology and Infectious Disease Canada, Canadian Society of Allergy and Clinical Immunology, Canadian Society of Otolaryngology-Head and Neck Surgery, Canadian Association of Emergency Physicians, and the Family Physicians Airways Group of Canada).
RESULTS: Diagnosis of ABRS is based on the presence of specific symptoms and their duration; imaging or culture are not needed in uncomplicated cases. Treatment is dependent on symptom severity, with intranasal corticosteroids (INCSs) recommended as monotherapy for mild and moderate cases, although the benefit might be modest. Use of INCSs plus antibiotics is reserved for patients who fail to respond to INCSs after 72 hours, and for initial treatment of patients with severe symptoms. Antibiotic selection must account for the suspected pathogen, the risk of resistance, comorbid conditions, and local antimicrobial resistance trends. Adjunct therapies such as nasal saline irrigation are recommended. Failure to respond to treatment, recurrent episodes, and signs of complications should prompt referral to an otolaryngologist. The guidelines address situations unique to the Canadian health care environment, including actions to take during prolonged wait periods for specialist referral or imaging.
CONCLUSIONS: The Canadian guidelines provide up-to-date recommendations for diagnosis and treatment of ABRS that reflect an evolving understanding of the disease. In addition, the guidelines offer useful tools to help clinicians discern viral from bacterial episodes, as well as optimally manage their patients with ABRS.
METHODS: Guideline authors performed a systematic literature search and drafted recommendations. Recommendations received both strength of evidence and strength of recommendation ratings. Input from external content experts was sought, as was endorsement from Canadian medical societies (Association of Medical Microbiology and Infectious Disease Canada, Canadian Society of Allergy and Clinical Immunology, Canadian Society of Otolaryngology-Head and Neck Surgery, Canadian Association of Emergency Physicians, and the Family Physicians Airways Group of Canada).
RESULTS: Diagnosis of ABRS is based on the presence of specific symptoms and their duration; imaging or culture are not needed in uncomplicated cases. Treatment is dependent on symptom severity, with intranasal corticosteroids (INCSs) recommended as monotherapy for mild and moderate cases, although the benefit might be modest. Use of INCSs plus antibiotics is reserved for patients who fail to respond to INCSs after 72 hours, and for initial treatment of patients with severe symptoms. Antibiotic selection must account for the suspected pathogen, the risk of resistance, comorbid conditions, and local antimicrobial resistance trends. Adjunct therapies such as nasal saline irrigation are recommended. Failure to respond to treatment, recurrent episodes, and signs of complications should prompt referral to an otolaryngologist. The guidelines address situations unique to the Canadian health care environment, including actions to take during prolonged wait periods for specialist referral or imaging.
CONCLUSIONS: The Canadian guidelines provide up-to-date recommendations for diagnosis and treatment of ABRS that reflect an evolving understanding of the disease. In addition, the guidelines offer useful tools to help clinicians discern viral from bacterial episodes, as well as optimally manage their patients with ABRS.
摘要：
目的：提供加拿大急性细菌性鼻鼻窦炎（ABRS）临床实践指南的临床总结，其中包括家庭医生的相关注意事项。
方法：指南作者进行了系统的文献检索并起草了建议。建议既有证据的强度，也有建议评级的强度。征求了外部内容专家的意见，来自加拿大医学会的认可(加拿大医学微生物学和传染病协会，加拿大过敏和临床免疫学会，加拿大耳鼻咽喉头颈外科学会，加拿大急诊医师协会，和加拿大家庭医生航空公司集团)。
结果：ABRS的诊断基于特定症状的存在及其持续时间；在简单的病例中不需要成像或培养。治疗取决于症状的严重程度，使用鼻内皮质类固醇（INCSs）推荐作为轻度和中度病例的单一疗法，虽然好处可能不大。对于72小时后对INCSs无反应的患者，保留使用INCSs加抗生素。以及严重症状患者的初始治疗。抗生素的选择必须考虑到可疑的病原体，抵抗的风险，合并症条件，和局部抗菌药物耐药趋势。建议使用辅助疗法，例如鼻腔盐水冲洗。对治疗没有反应，反复发作,并发症的迹象应促使转诊至耳鼻喉科医师。该指南针对加拿大医疗保健环境特有的情况，包括在长时间等待专家转诊或成像期间采取的措施。
结论：加拿大指南为ABRS的诊断和治疗提供了最新的建议，反映了对该疾病不断发展的认识。此外,该指南提供了有用的工具来帮助临床医生辨别病毒和细菌发作，以及最佳管理ABRS患者。
方法：指南作者进行了系统的文献检索并起草了建议。建议既有证据的强度，也有建议评级的强度。征求了外部内容专家的意见，来自加拿大医学会的认可(加拿大医学微生物学和传染病协会，加拿大过敏和临床免疫学会，加拿大耳鼻咽喉头颈外科学会，加拿大急诊医师协会，和加拿大家庭医生航空公司集团)。
结果：ABRS的诊断基于特定症状的存在及其持续时间；在简单的病例中不需要成像或培养。治疗取决于症状的严重程度，使用鼻内皮质类固醇（INCSs）推荐作为轻度和中度病例的单一疗法，虽然好处可能不大。对于72小时后对INCSs无反应的患者，保留使用INCSs加抗生素。以及严重症状患者的初始治疗。抗生素的选择必须考虑到可疑的病原体，抵抗的风险，合并症条件，和局部抗菌药物耐药趋势。建议使用辅助疗法，例如鼻腔盐水冲洗。对治疗没有反应，反复发作,并发症的迹象应促使转诊至耳鼻喉科医师。该指南针对加拿大医疗保健环境特有的情况，包括在长时间等待专家转诊或成像期间采取的措施。
结论：加拿大指南为ABRS的诊断和治疗提供了最新的建议，反映了对该疾病不断发展的认识。此外,该指南提供了有用的工具来帮助临床医生辨别病毒和细菌发作，以及最佳管理ABRS患者。
