Management of acute rhinosinusitis, bronchitis syndromes, and acute otitis media

PURPOSE: The most common community-acquired acute respiratory illnesses (ARIs) are acute rhinosinusitis, acute bronchitis/acute exacerbation of chronic bronchitis in adults, and acute otitis media in children. This review focuses on the judicious use of empiric antimicrobial therapy for the treatment of these syndromes. EPIDEMIOLOGY: ARIs affect 30 million patients in the United States and cost approximately US$1.3 billion annually. They are the most common indications for prescription of antimicrobial agents. REVIEW SUMMARY: Identifying patients who have bacterial ARIs is essential to curbing inappropriate antimicrobial use and related escalation in costs. The most common bacterial causes of ARIs include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Approximately 25% of S pneumoniae are resistant to penicillins and macrolides, whereas one third of H influenzae and nearly 100% of M catarrhalis produce β-lactamases. Because 15% to 75% of patients with bacterial ARIs may recover spontaneously, antimicrobials should be used as per published guidelines. Finally, minimizing/eliminating exposure to risk factors for ARIs (eg, smoking, allergens) and emphasizing protective practices such as breast-feeding in infancy are essential as preventive measures. TYPE OF AVAILABLE EVIDENCE: Systematic reviews/meta-analyses, randomized-controlled trials, controlled prospective and retrospective cohort studies, and unstructured reviews. GRADE OF AVAILABLE EVIDENCE: Good. CONCLUSION: ARIs are a significant cause of morbidity and contribute significantly to US health costs. The diagnosis of ARIs is mainly clinical and treatment remains largely empiric; awareness in addition to practice of published guidelines for diagnosis and treatment of these syndromes is crucial. Antimicrobial therapy should be used selectively and preventive measures considered whenever feasible.