By vgreene, 12 September, 2016 Viral URIs typically last 5-10 days w/ severity peaking in 3-6 days, and occasionally sx last >10 days (AAP,1 IDSA2)
By vgreene, 12 September, 2016 Immediate abx in pts w complicated ABRS 1 3 order imaging consult specialist
By vgreene, 12 September, 2016 Consider sx relief: nasal steroids (AAI-JTF,17 IDSA18); saline irrigations (IDSA19). IDSA recommends against antihistamines, decongestants.20 AAP makes no recommendation regarding sx relief tx21
By vgreene, 12 September, 2016 Consider referral to allergy/immunology, ID, or ENT, and cx of direct sinus aspirate (IDSA15); also consider referral to ophthalmology for orbital complications or neurosurgery for intracranial infxns (AAP16)
By vgreene, 12 September, 2016 Tx other severe/hospitalized pts or those unable to take PO w/ IV ceftriaxone, cefotaxime, or alternatives (AAP,11 IDSA12)
By vgreene, 12 September, 2016 Tx orbital/intracranial infxn in hosp w/ IV abx; vancomycin (to cover MRSA) + ceftriaxone, ampicillin/sulbactam, or piperacillin/tazobactam +/- metronidazole (to cover anaerobes; include metronidazole if ceftriaxone used for intracranial infx) (AAP11)
By vgreene, 12 September, 2016 If suspected orbital/intracranial extension, contrast CT sinuses/orbits +/- head (for intracranial study) (ACR7); contrast CT or contrast MRI recommended (AAI-JTF,8 AAP,9 IDSA10)
By vgreene, 12 September, 2016 Urgent attention if orbital swelling/pain, proptosis, severe HA, forehead/facial swelling, cranial nerve palsy, abnormal EOMs, visual disturbance/diplopia, photophobia, sz, focal neuro signs, systemic toxicity, altered mental status, meningeal signs, rapi
