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El Feghaly RE, Jaggi P, Katz SE, Poole NM. "Give Me Five": The Case for 5 Days of Antibiotics as the Default Duration for Acute Respiratory Tract Infections. J Pediatric Infect Dis Soc 2024; 13:328-333. [PMID: 38581154 DOI: 10.1093/jpids/piae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/04/2024] [Indexed: 04/08/2024]
Abstract
Acute respiratory tract infections (ARTIs) account for most antibiotic prescriptions in pediatrics. Although US guidelines continue to recommend ≥10 days antibiotics for common ARTIs, evidence suggests that 5-day courses can be safe and effective. Academic imprinting seems to play a major role in the continued use of prolonged antibiotic durations. In this report, we discuss the evidence supporting short antibiotic courses for group A streptococcal pharyngitis, acute otitis media, and acute bacterial rhinosinusitis. We discuss the basis for prolonged antibiotic course recommendations and recent literature investigating shorter courses. Prescribers in the United States should overcome academic imprinting and follow international trends to reduce antibiotic durations for common ARTIs, where 5 days is a safe and efficacious course when antibiotics are prescribed.
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Affiliation(s)
- Rana E El Feghaly
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Preeti Jaggi
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Sophie E Katz
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nicole M Poole
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
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2
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Liu SH, Chen YY, Nurmatov U, van Schayck OCP, Kuo IC. Antibiotics Versus Placebo for Acute Bacterial Conjunctivitis: Findings From a Cochrane Systematic Review. Am J Ophthalmol 2024; 257:143-153. [PMID: 37482371 PMCID: PMC10799969 DOI: 10.1016/j.ajo.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE To summarize key findings from a Cochrane review of the benefits and safety of antibiotic therapy compared with placebo (or vehicle) for acute bacterial conjunctivitis. DESIGN Systematic review and meta-analysis. METHODS We included placebo-controlled randomized controlled trials (RCTs) that compared topical antibiotics with placebo. We followed Cochrane methods for trial selection, data extraction, risk of bias assessment, and evidence synthesis. RESULTS Twenty-one RCTs involving 8805 participants with acute bacterial conjunctivitis were included. Fifteen (71%) RCTs examined fluoroquinolone (FQ) drops, 3 tested macrolides, alone or in combination with steroids, and another 3 compared other non-FQ antibiotics. Intention-to-treat estimates suggested that compared with placebo, antibiotics may increase clinical recovery by 26% (risk ratio [RR]: 1.26; 95% confidence interval [CI]: 1.09-1.46) at the end of therapy (5 RCTs, 1474 participants). Modified intention-to-treat estimates, in which only participants with laboratory-confirmed bacterial conjunctivitis were analyzed, indicated that antibiotics were associated with 53% higher likelihood of microbiological cure as compared with placebo (RR: 1.53; 95% CI: 1.34-1.74; 10 RCTs, 2827 participants). Non-FQs (RR: 4.05; 95% CI: 1.36-12.00), but not FQs (RR: 0.70; 95% CI: 0.54-0.90), were likely to increase treatment-associated ocular complications such as eye pain, discomfort, and allergic reactions; the certainty of level of evidence was very low. CONCLUSIONS Moderate level certainty of evidence suggested that antibiotics may increase the likelihood of clinical recovery and microbiological clearance compared with placebo. Very low-level certainty of evidence suggested that antibiotics may be associated with potential harm in patients with acute bacterial conjunctivitis, but the potential risk of bias from study design, inconsistency in outcome measurement, and reporting limit the evidence to very low certainty.
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Affiliation(s)
- Su-Hsun Liu
- From the Department of Ophthalmology, School of Medicine (S.-H.L.); Department of Epidemiology, School of Public Health (S.-H.L.), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Yu-Yen Chen
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan (Y.-Y.C.); Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA (Y.-Y.C., I.C.K.); School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (Y.-Y.C.)
| | - Ulugbek Nurmatov
- Division of Population Medicine, School of Medicine, the National Centre for Population Health and Wellbeing Research, Cardiff University, Cardiff, UK (U.N.)
| | - Onno C P van Schayck
- Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, the Netherlands (O.C.P.V.S)
| | - Irene C Kuo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA (Y.-Y.C., I.C.K.).
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3
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Shochat I, Grinblat G, Levine H, Braverman I. Safety of a New Sinus Irrigation Device in Rhinosinusitis: A Pilot Study. EAR, NOSE & THROAT JOURNAL 2023; 102:NP400-NP407. [PMID: 33975441 DOI: 10.1177/01455613211015417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Puncture and lavage of the paranasal sinuses, previously the primary treatment for unresponsive acute bacterial rhinosinusitis before surgery, has been abandoned due to procedural discomfort and advancements in antibiotic efficacy and endoscopic surgery. The rise in antibiotic-resistant bacteria has renewed the interest in minimally invasive sinus lavage to both avoid aggressive surgical interventions and identify appropriate antibiotic therapy. In this article, we describe the safety and feasibility of a new device in human patients and evaluate its efficacy as a treatment before the traditional sinus surgery in acute rhinosinusitis. METHODS The device with its seeker-shaped guiding tube and rotating wire can enter the sinus cavity through the natural ostium, pulverize the inspissated mucus, and enable lavage and culture sampling without the need for sinus puncturing. It was tested in 6 patients with chronic sinusitis under general anesthesia during endoscopic sinus surgery and in additional 10 patients with maxillary acute bacterial rhinosinusitis in outpatient settings under local anesthesia. RESULTS The device enabled rapid, efficient, and atraumatic insertion of the wire into the occluded sinuses. The rotating wire permitted pulverization of the thick mucus, which enabled irrigation without mucosal damage or adverse events. Overall, 9 of 10 patients with acute bacterial rhinosinusitis demonstrated remarkable improvements and were discharged the following day with no acute symptoms. The visual analog scale score for pain dropped from 8.9 to 0.4. The remaining one patient underwent endoscopic sinus surgery subsequently. None of the patients treated during endoscopic sinus surgery developed any adverse events.
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Affiliation(s)
- Isaac Shochat
- Hillel Yaffe Medical Center, Hadera, Israel, Technion Faculty of Medicine, Haifa, Israel
| | - Golda Grinblat
- Hillel Yaffe Medical Center, Hadera, Israel, Technion Faculty of Medicine, Haifa, Israel
| | - Howard Levine
- Cleveland Nasal Sinus & Sleep Center, Head and Neck Institute, The Cleveland Clinic, OH, USA
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera, Israel, Technion Faculty of Medicine, Haifa, Israel
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4
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Sabatino L, Pierri M, Iafrati F, Di Giovanni S, Moffa A, De Benedetto L, Passarelli PC, Casale M. Odontogenic Sinusitis from Classical Complications and Its Treatment: Our Experience. Antibiotics (Basel) 2023; 12:antibiotics12020390. [PMID: 36830300 PMCID: PMC9952703 DOI: 10.3390/antibiotics12020390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/09/2023] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
Odontogenic sinusitis (ODS) refers to the maxillary sinus infection, which is secondary to either adjacent infectious dental pathologies or procedures. The aim of this retrospective study is to report the experiences of the department of integrated therapies in otolaryngology (Campus Bio-Medico Foundation, Rome, Italy) in classifying and treating patients that are affected by odontogenic sinusitis derived from "classic complications". A total of 68 patients responding to the criteria and to the definition as a classical odontogenic complication were included. The surgical therapy consisted of a combined oral and nasal simultaneous approach for 28 patients (43%), a combined non-simultaneous approach for 4 patients (6%), a nasal only approach for 14 patients (21%), and an oral only approach for 20 patients (30%). All the patients presented a complete resolution of the symptoms. The choice of performing a nasal, oral, or combined approach is based on the presence of anatomical elements that facilitate sinusitis and reinfection occurrence, such as deviated nasal septum, concha bullosa, or obstructed osteo-meatal complex. The correct use of validated classification, the pre-operative CT scan, a multidisciplinary approach, and an appropriate presurgical examination are the necessary elements to obtain a good success rate.
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Affiliation(s)
- Lorenzo Sabatino
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Correspondence:
| | - Michelangelo Pierri
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Francesco Iafrati
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Simone Di Giovanni
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Antonio Moffa
- Department of Head and Neck, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli, 00128 Rome, Italy
| | - Luigi De Benedetto
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Pier Carmine Passarelli
- Department of Head and Neck, Division of Oral Surgery and Implantology, Institute of Clinical Dentistry, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Gemelli, 00128 Rome, Italy
| | - Manuele Casale
- Unit of Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Unit of Integrated Therapies in Otolaryngology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
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Taw MB, Nguyen CT, Wang MB. Integrative Approach to Rhinosinusitis: An Update. Otolaryngol Clin North Am 2022; 55:947-963. [PMID: 36088158 DOI: 10.1016/j.otc.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Rhinosinusitis is characterized by inflammation of the mucosa involving the paranasal sinuses and the nasal cavity and is one of the most common and significant health care problems, with significant impairment of quality of life. Current standard conventional management of rhinosinusitis commonly uses multiple therapeutic modalities to break the cycle of chronic disease. However, to date, there is no consensus as to the optimal treatment algorithm for patients with chronic rhinosinusitis. There is a growing interest in the use of complementary and integrative medicine for the treatment of rhinosinusitis. This article update focuses on an integrative approach to rhinosinusitis.
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Affiliation(s)
- Malcolm B Taw
- UCLA Center for East-West Medicine, 1250 La Venta Drive, Suite 101A, Westlake Village, CA 91361, USA.
| | - Chau T Nguyen
- Division of Otolaryngology-Head & Neck Surgery, Ventura County Medical Center, 300 Hillmont Avenue, Suite 401, Ventura, CA 93003, USA
| | - Marilene B Wang
- UCLA Department of Head and Neck Surgery, 200 UCLA Medical Plaza, Suite 550, Los Angeles, CA 90095, USA
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Abstract
Based on a review of the most current medical literature, this article outlines the basic concepts and classifications of rhinosinusitis, and delineates best practices for clinical diagnoses and the most up-to-date management strategies. Learning to recognize and differentiate these conditions helps facilitate appropriate and timely diagnoses as well as helping practitioners provide their patients with better counseling and care.
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Affiliation(s)
- Benjamin S Bleier
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
| | - Marianella Paz-Lansberg
- Clinical Fellow of Rhinology & Skull Base Surgery, Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
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7
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Nosulya EV, Kunelskaya NL, Kim IA. [Systemic and local antibiotic therapy for acute sinusitis]. Vestn Otorinolaringol 2020; 85:40-43. [PMID: 33140932 DOI: 10.17116/otorino20208505140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of the study was to summarize data on modern antibiotic therapy for acute sinusitis, the role and place of topical antibacterial drugs, in particular Fluimucil-Antibiotic, in modern treatment strategies for this disease. METHODS Search in the PUBMED electronic database (articles and related abstracts) for the keywords «acute sinusitis", «antibiotics», «thiamphenicol glycinate acetylcysteine» «biofilm», «respiratory tract infection», «N-acetylcysteine». RESULTS The published research results indicate the high antibacterial activity of the Fluimucil-Antibiotic, in particular, for the topical drug use in the form of inhalations, applications, irrigation, and instillations. The published research results indicate a wide spectrum of antimicrobial action of Fluimucil-Antibiotic, its ability to destroy biofilms and prevent their formation, good pharmacokinetics, safety, which makes it possible to consider it as a potential treatment option for acute sinusitis in everyday practice.
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Affiliation(s)
- E V Nosulya
- Research Clinical Institute of Otorinolaryngology named after. L.I. Sverzhevsky, Moscow, Russia
| | - N L Kunelskaya
- Research Clinical Institute of Otorinolaryngology named after. L.I. Sverzhevsky, Moscow, Russia.,N.I. Pirogov Russian National Research Medical University, Moscow, Russia
| | - I A Kim
- National Medical Research Center of Otorhinolaryngology of the Federal Medical and Biological Agency, Moscow, Russia
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Lemiengre MB, van Driel ML, Merenstein D, Liira H, Mäkelä M, De Sutter AIM. Antibiotics for acute rhinosinusitis in adults. Cochrane Database Syst Rev 2018; 9:CD006089. [PMID: 30198548 PMCID: PMC6513448 DOI: 10.1002/14651858.cd006089.pub5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Acute rhinosinusitis is an acute infection of the nasal passages and paranasal sinuses that lasts less than four weeks. Diagnosis of acute rhinosinusitis is generally based on clinical signs and symptoms in ambulatory care settings. Technical investigations are not routinely performed, nor are they recommended in most countries. Some trials show a trend in favour of antibiotics, but the balance of benefit versus harm is unclear.We merged two Cochrane Reviews for this update, which comprised different approaches with overlapping populations, resulting in different conclusions. For this review update, we maintained the distinction between populations diagnosed by clinical signs and symptoms, or imaging. OBJECTIVES To assess the effects of antibiotics versus placebo or no treatment in adults with acute rhinosinusitis in ambulatory care settings. SEARCH METHODS We searched CENTRAL (2017, Issue 12), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (January 1950 to January 2018), Embase (January 1974 to January 2018), and two trials registers (January 2018). We also checked references from identified trials, systematic reviews, and relevant guidelines. SELECTION CRITERIA Randomised controlled trials of antibiotics versus placebo or no treatment in people with rhinosinusitis-like signs or symptoms or sinusitis confirmed by imaging. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data about cure and side effects and assessed the risk of bias. We contacted trial authors for additional information as required. MAIN RESULTS We included 15 trials involving 3057 participants. Of the 15 included trials, 10 appeared in our 2012 review, and five (631 participants) are legacy trials from merging two reviews. No new studies were included from searches for this update. Overall, risk of bias was low. Without antibiotics, 46% of participants with rhinosinusitis, whether or not confirmed by radiography, were cured after 1 week and 64% after 14 days. Antibiotics can shorten time to cure, but only 5 to 11 more people per 100 will be cured faster if they receive antibiotics instead of placebo or no treatment: clinical diagnosis (odds ratio (OR) 1.25, 95% confidence interval (CI) 1.02 to 1.54; number needed to treat for an additional beneficial outcome (NNTB) 19, 95% CI 10 to 205; I² = 0%; 8 trials; high-quality evidence) and diagnosis confirmed by radiography (OR 1.57, 95% CI 1.03 to 2.39; NNTB 10, 95% CI 5 to 136; I² = 0%; 3 trials; moderate-quality evidence). Cure rates with antibiotics were higher when a fluid level or total opacification in any sinus was found on computed tomography (OR 4.89, 95% CI 1.75 to 13.72; NNTB 4, 95% CI 2 to 15; 1 trial; moderate-quality evidence). Purulent secretion resolved faster with antibiotics (OR 1.58, 95% CI 1.13 to 2.22; NNTB 10, 95% CI 6 to 35; I² = 0%; 3 trials; high-quality evidence). However, 13 more people experienced side effects with antibiotics compared to placebo or no treatment (OR 2.21, 95% CI 1.74 to 2.82; number needed to treat for an additional harmful outcome (NNTH) 8, 95% CI 6 to 12; I² = 16%; 10 trials; high-quality evidence). Five fewer people per 100 will experience clinical failure if they receive antibiotics instead of placebo or no treatment (Peto OR 0.48, 95% CI 0.36 to 0.63; NNTH 19, 95% CI 15 to 27; I² = 21%; 12 trials; high-quality evidence). A disease-related complication (brain abscess) occurred in one participant (of 3057) one week after receiving open antibiotic therapy (clinical failure, control group). AUTHORS' CONCLUSIONS The potential benefit of antibiotics to treat acute rhinosinusitis diagnosed either clinically (low risk of bias, high-quality evidence) or confirmed by imaging (low to unclear risk of bias, moderate-quality evidence) is marginal and needs to be seen in the context of the risk of adverse effects. Considering antibiotic resistance, and the very low incidence of serious complications, we conclude there is no place for antibiotics for people with uncomplicated acute rhinosinusitis. We could not draw conclusions about children, people with suppressed immune systems, and those with severe sinusitis, because these populations were not included in the available trials.
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Affiliation(s)
- Marieke B Lemiengre
- Ghent UniversityDepartment of Family Medicine and Primary Health CareCampus UZ 6K3, Corneel Heymanslaan 10GhentBelgium9000
| | - Mieke L van Driel
- Ghent UniversityDepartment of Family Medicine and Primary Health CareCampus UZ 6K3, Corneel Heymanslaan 10GhentBelgium9000
- Bond UniversityCentre for Research in Evidence‐Based Practice (CREBP)Gold CoastQueenslandAustralia4229
- The University of QueenslandPrimary Care Clinical Unit, Faculty of MedicineBrisbaneQueenslandAustralia4029
| | - Dan Merenstein
- Georgetown University Medical CenterDepartment of Family Medicine215 Kober Cogan Hall3750 Reservoir Road, NWWashingtonDCUSA20007
| | | | - Marjukka Mäkelä
- THL (National Institute for Health and Welfare)PO Box 30HelsinkiFinland00271
- University of CopenhagenDepartment of Public Health / Unit of General PracticeP.O.Box 2099DK‐1014 CopenhagenDenmark
| | - An IM De Sutter
- Ghent UniversityDepartment of Family Medicine and Primary Health CareCampus UZ 6K3, Corneel Heymanslaan 10GhentBelgium9000
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Abstract
Rhinitis and sinusitis are common medical conditions that affect the geriatric population and have a significant impact on their quality of life. Because few studies examine differences in the clinical management between the geriatric and general adult population, therapies should be based on current guidelines. Special considerations should be made when treating these patients in regards to multiple comorbidities and the potential for drug interactions from polypharmacy. Further research on the pathogenesis of sinusitis in the geriatric population may provide specific differences in the clinical management in this population.
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Affiliation(s)
- Richard M Rosenfeld
- From the Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn
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McMullan BJ, Andresen D, Blyth CC, Avent ML, Bowen AC, Britton PN, Clark JE, Cooper CM, Curtis N, Goeman E, Hazelton B, Haeusler GM, Khatami A, Newcombe JP, Osowicki J, Palasanthiran P, Starr M, Lai T, Nourse C, Francis JR, Isaacs D, Bryant PA. Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines. THE LANCET. INFECTIOUS DISEASES 2016; 16:e139-52. [PMID: 27321363 DOI: 10.1016/s1473-3099(16)30024-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 03/04/2016] [Accepted: 03/29/2016] [Indexed: 12/22/2022]
Abstract
Few studies are available to inform duration of intravenous antibiotics for children and when it is safe and appropriate to switch to oral antibiotics. We have systematically reviewed antibiotic duration and timing of intravenous to oral switch for 36 paediatric infectious diseases and developed evidence-graded recommendations on the basis of the review, guidelines, and expert consensus. We searched databases and obtained information from references identified and relevant guidelines. All eligible studies were assessed for quality. 4090 articles were identified and 170 studies were included. Evidence relating antibiotic duration to outcomes in children for some infections was supported by meta-analyses or randomised controlled trials; in other infections data were from retrospective series only. Criteria for intravenous to oral switch commonly included defervescence and clinical improvement with or without improvement in laboratory markers. Evidence suggests that intravenous to oral switch can occur earlier than previously recommended for some infections. We have synthesised recommendations for antibiotic duration and intravenous to oral switch to support clinical decision making and prospective research.
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Affiliation(s)
- Brendan J McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, NSW, Australia
| | - David Andresen
- Department of Infectious Diseases, Immunology, and HIV Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, WA, Australia; PathWest Laboratory Medicine, WA, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, WA, Australia
| | - Minyon L Avent
- The University of Queensland, UQ Centre for Clinical Research and School of Public Health, Herston, QLD, Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, WA, Australia; Menzies School of Health Research, Darwin, NT, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, WA, Australia
| | - Philip N Britton
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Julia E Clark
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Celia M Cooper
- Department of Microbiology and Infectious Diseases, SA Pathology, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Nigel Curtis
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Emma Goeman
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Briony Hazelton
- Sydney Medical School, University of Sydney, NSW, Australia; Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia
| | - Gabrielle M Haeusler
- Department of Infectious Diseases and Infection Control, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Infection and Immunity, Monash Children's Hospital, Clayton, VIC, Australia
| | - Ameneh Khatami
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - James P Newcombe
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Joshua Osowicki
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Pamela Palasanthiran
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, NSW, Australia
| | - Mike Starr
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Tony Lai
- Department of Pharmacy, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Clare Nourse
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Joshua R Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
| | - David Isaacs
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
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Ahovuo‐Saloranta A, Rautakorpi U, Borisenko OV, Liira H, Williams Jr JW, Mäkelä M. WITHDRAWN: Antibiotics for acute maxillary sinusitis in adults. Cochrane Database Syst Rev 2015; 2015:CD000243. [PMID: 26471061 PMCID: PMC10775754 DOI: 10.1002/14651858.cd000243.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Currently, two separate Cochrane reviews, ‘Antibiotics for acute maxillary sinusitis in adults ’ and ‘Antibiotics for clinically diagnosed acute rhinosinusitis in adults ’ describe the effect of antibiotics for acute rhinosinusitis. Although both Cochrane reviews study the same condition, they look at different populations (patients in which the diagnosis was based on clinical signs and symptoms and patients in which the diagnosis was confirmed by imaging). Because of this, the conclusions are different in these Cochrane reviews. This was confusing for clinicians who needed to read both Cochrane reviews to know which conclusions are most applicable to their patients.
This review is being withdrawn and will be incorporated into the updated publication of ‘Antibiotics for clinically diagnosed acute rhinosinusitis in adults ’. This ‘merged’ review will still maintain the relevant distinction between the two populations. However, information on the effectiveness of antibiotics for rhinosinusitis will be published in the ‘merged’ Cochrane review. We will omit the comparison between antibiotics (as published in this Cochrane review) because the choice for certain antibiotics and/or doses differs according to the local antibiotic resistance patterns and therefore this comparison is less relevant. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Anneli Ahovuo‐Saloranta
- National Institute for Health and Welfare (THL)Finnish Office for Health Technology Assessment (FinOHTA)Finn‐Medi 3, Biokatu 10TampereFinlandFI‐33520
| | - Ulla‐Maija Rautakorpi
- National Institute for Health and Welfare (THL), Tampere officeFinnish Office for Health Technology Assessment (FinOHTA)Finn‐Medi 3, Biokatu 10TampereFinlandFI‐33520
| | | | - Helena Liira
- The University of Western AustraliaSchool of Primary, Aboriginal and Rural Health Care35 Stirling HighwayCrawleyWestern AustraliaAustralia6009
| | - John W Williams Jr
- Durham VAMC and Duke University Medical CenterDepartments of Medicine and Psychiatry411 W Chapel Hill St, Suite 500DurhamNCUSA27701
| | - Marjukka Mäkelä
- National Institute for Health and Welfare (THL)Finnish Office for Health Technology Assessment (FinOHTA)PO Box 30HelsinkiFinlandFIN‐00271
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Antibiotic efficacy in patients with a moderate probability of acute rhinosinusitis: a systematic review. Eur Arch Otorhinolaryngol 2015; 273:1067-77. [DOI: 10.1007/s00405-015-3506-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
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Matsuba Y, Strassen U, Hofauer B, Bas M, Knopf A. Orbital complications:diagnosis of different rhinological causes. Eur Arch Otorhinolaryngol 2014; 272:2319-26. [PMID: 25323154 DOI: 10.1007/s00405-014-3338-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 10/11/2014] [Indexed: 11/28/2022]
Abstract
To evaluate the clinical course of orbital complication using a standardised diagnostic pathway. Seventy-three patients with orbital complications underwent a multimodal diagnostic pathway comprising ENT examination, leucocytes/CRP, CT-/MRI-scanning and disease-related data. Twenty-nine patients suffered from rhinosinusitis, 28 from mucoceles, 13 patients from neoplasms and three patients from rheumatic disorders. Clinical examination diagnosed 60 patients with eyelid swelling, 55 patients with ocular pain, 14 patients with diplopia, 4 patients with exophthalmus, 29 patients with visual field defect and 4 patients with visual loss. The diagnostic pathway identified acute rhinosinusitis with a sensitivity/specificity of 90 %/90 %, mucoceles with 79 %/100 %, neoplasms with 100 %/96 % and granulomatosis with polyangiitis with 100 %/100 %, respectively. All patients left the hospital in good general condition and with regular ocular motility; two patients suffered persistent visual loss. The standardised application of a widely accepted diagnostic pathway reliably distinguishes different causes of orbital complication.
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Affiliation(s)
- Yumiko Matsuba
- Hals-, Nasen-, Ohrenklinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
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Ahovuo-Saloranta A, Rautakorpi UM, Borisenko OV, Liira H, Williams JW, Mäkelä M. Antibiotics for acute maxillary sinusitis in adults. Cochrane Database Syst Rev 2014:CD000243. [PMID: 24515610 DOI: 10.1002/14651858.cd000243.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sinusitis is one of the most common diagnoses among adults in ambulatory care, accounting for 15% to 21% of all adult outpatient antibiotic prescriptions. However, the role of antibiotics for sinusitis is controversial. OBJECTIVES To assess the effects of antibiotics in adults with acute maxillary sinusitis by comparing antibiotics with placebo, antibiotics from different classes and the side effects of different treatments. SEARCH METHODS We searched CENTRAL 2013, Issue 2, MEDLINE (1946 to March week 3, 2013), EMBASE (1974 to March 2013), SIGLE (OpenSIGLE, later OpenGrey (accessed 15 January 2013)), reference lists of the identified trials and systematic reviews of placebo-controlled studies. We also searched for ongoing trials via ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). We imposed no language or publication restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing antibiotics with placebo or antibiotics from different classes for acute maxillary sinusitis in adults. We included trials with clinically diagnosed acute sinusitis, confirmed or not by imaging or bacterial culture. DATA COLLECTION AND ANALYSIS Two review authors independently screened search results, extracted data and assessed trial quality. We calculated risk ratios (RRs) for differences between intervention and control groups in whether the treatment failed or not. All measures are presented with 95% confidence intervals (CIs). We conducted the meta-analyses using either the fixed-effect or random-effects model. In meta-analyses of the placebo-controlled studies, we combined data across antibiotic classes. Primary outcomes were clinical failure rates at 7 to 15 days and 16 to 60 days follow-up. We used GRADEpro to assess the quality of the evidence. MAIN RESULTS We included 63 studies in this updated review; nine placebo-controlled studies involving 1915 participants (seven of the studies clearly conducted in primary care settings) and 54 studies comparing different classes of antibiotics (10 different comparisons). Five studies at low risk of bias comparing penicillin or amoxicillin to placebo provided information on the main outcome: clinical failure rate at 7 to 15 days follow-up, defined as a lack of full recovery or improvement, for participants with symptoms lasting at least seven days. In these studies antibiotics decreased the risk of clinical failure (pooled RR of 0.66, 95% CI 0.47 to 0.94, 1084 participants randomised, 1058 evaluated, moderate quality evidence). However, the clinical benefit was small. Cure or improvement rates were high in both the placebo group (86%) and the antibiotic group (91%) in these five studies. When clinical failure was defined as a lack of full recovery (n = five studies), results were similar: antibiotics decreased the risk of failure (pooled RR of 0.73, 95% CI 0.63 to 0.85, high quality evidence) at 7 to 15 days follow-up.Adverse effects in seven of the nine placebo-controlled studies (comparing penicillin, amoxicillin, azithromycin or moxicillin to placebo) were more common in antibiotic than in placebo groups (median of difference between groups 10.5%, range 2% to 23%). However, drop-outs due to adverse effects were rare in both groups: 1.5% in antibiotic groups and 1% in control groups.In the 10 head-to-head comparisons, none of the antibiotic preparations were superior to another. However, amoxicillin-clavulanate had significantly more drop-outs due to adverse effects than cephalosporins and macrolides. AUTHORS' CONCLUSIONS There is moderate evidence that antibiotics provide a small benefit for clinical outcomes in immunocompetent primary care patients with uncomplicated acute sinusitis. However, about 80% of participants treated without antibiotics improved within two weeks. Clinicians need to weigh the small benefits of antibiotic treatment against the potential for adverse effects at both the individual and general population levels.
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Affiliation(s)
- Anneli Ahovuo-Saloranta
- Finnish Office for Health Technology Assessment (FinOHTA), National Institute for Health and Welfare (THL), Tampere office, Finn-Medi 3, Biokatu 10, Tampere, Finland, FI-33520
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Thompson M, Vodicka TA, Blair PS, Buckley DI, Heneghan C, Hay AD. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013; 347:f7027. [PMID: 24335668 PMCID: PMC3898587 DOI: 10.1136/bmj.f7027] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To determine the expected duration of symptoms of common respiratory tract infections in children in primary and emergency care. DESIGN Systematic review of existing literature to determine durations of symptoms of earache, sore throat, cough (including acute cough, bronchiolitis, and croup), and common cold in children. DATA SOURCES PubMed, DARE, and CINAHL (all to July 2012). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials or observational studies of children with acute respiratory tract infections in primary care or emergency settings in high income countries who received either a control treatment or a placebo or over-the-counter treatment. Study quality was assessed with the Cochrane risk of bias framework for randomised controlled trials, and the critical appraisal skills programme framework for observational studies. MAIN OUTCOME MEASURES Individual study data and, when possible, pooled daily mean proportions and 95% confidence intervals for symptom duration. Symptom duration (in days) at which each symptom had resolved in 50% and 90% of children. RESULTS Of 22,182 identified references, 23 trials and 25 observational studies met inclusion criteria. Study populations varied in age and duration of symptoms before study onset. In 90% of children, earache was resolved by seven to eight days, sore throat between two and seven days, croup by two days, bronchiolitis by 21 days, acute cough by 25 days, common cold by 15 days, and non-specific respiratory tract infections symptoms by 16 days. CONCLUSIONS The durations of earache and common colds are considerably longer than current guidance given to parents in the United Kingdom and the United States; for other symptoms such as sore throat, acute cough, bronchiolitis, and croup the current guidance is consistent with our findings. Updating current guidelines with new evidence will help support parents and clinicians in evidence based decision making for children with respiratory tract infections.
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Affiliation(s)
- Matthew Thompson
- Department of Family Medicine, Box 354696, University of Washington, Seattle, WA 98195-4696, USA
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Abstract
Rhinosinusitis is characterized by inflammation of the mucosa involving the paranasal sinuses and the nasal cavity and is one of the most common health care problems, with significant impairment of quality of life. There is a growing amount of interest in the use of complementary and integrative medicine for the treatment of rhinosinusitis. This article focuses on an integrative approach to rhinosinusitis.
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Affiliation(s)
- Malcolm B Taw
- UCLA Center for East-West Medicine, Department of Medicine, Santa Monica, CA 90404, USA.
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Abstract
Acute rhinosinusitis is a common illness in children. Viral upper respiratory tract infection is the most common presentation of rhinosinusitis. Most children resolve the infection spontaneously and only a small proportion develops a secondary bacterial infection. The proper choice of antibiotic therapy depends on the likely infecting pathogens, bacterial antibiotic resistance, and pharmacologic profiles of antibiotics. Amoxicillin-clavulanate is currently recommended as the empiric treatment in those requiring antimicrobial therapy. Isolation of the causative agents should be considered in those who failed the initial treatment. In addition to antibiotics, adjuvant therapies and surgery may be used in the management of acute bacterial rhinosinusitis.
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Rosenfeld RM, Shiffman RN, Robertson P. Clinical Practice Guideline Development Manual, Third Edition: a quality-driven approach for translating evidence into action. Otolaryngol Head Neck Surg 2013; 148:S1-55. [PMID: 23243141 DOI: 10.1177/0194599812467004] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Guidelines translate best evidence into best practice. A well-crafted guideline promotes quality by reducing health care variations, improving diagnostic accuracy, promoting effective therapy, and discouraging ineffective-or potentially harmful-interventions. Despite a plethora of published guidelines, methodology is often poorly defined and varies greatly within and among organizations. PURPOSE The third edition of this manual describes the principles and practices used successfully by the American Academy of Otolaryngology--Head and Neck Surgery Foundation to produce quality-driven, evidence-based guidelines using efficient and transparent methodology for actionable recommendations with multidisciplinary applicability. The development process emphasizes a logical sequence of key action statements supported by amplifying text, action statement profiles, and recommendation grades linking action to evidence. New material in this edition includes standards for trustworthy guidelines, updated classification of evidence levels, increased patient and public involvement, assessing confidence in the evidence, documenting differences of opinion, expanded discussion of conflict of interest, and use of computerized decision support for crafting actionable recommendations. CONCLUSION As clinical practice guidelines become more prominent as a key metric of quality health care, organizations must develop efficient production strategies that balance rigor and pragmatism. Equally important, clinicians must become savvy in understanding what guidelines are--and are not--and how they are best used to improve care. The information in this manual should help clinicians and organizations achieve these goals.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, State University of New York Downstate, Medical Center, Brooklyn, New York 11201, USA.
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Lemiengre MB, van Driel ML, Merenstein D, Young J, De Sutter AIM. Antibiotics for clinically diagnosed acute rhinosinusitis in adults. Cochrane Database Syst Rev 2012; 10:CD006089. [PMID: 23076918 DOI: 10.1002/14651858.cd006089.pub4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In primary care settings, the diagnosis of rhinosinusitis is generally based on clinical signs and symptoms. Technical investigations are not routinely performed, nor recommended. Individual trials show a trend in favour of antibiotics, but the balance of benefit versus harm is unclear. OBJECTIVES To assess the effect of antibiotics in adults with clinically diagnosed rhinosinusitis in primary care settings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2012), MEDLINE (January 1950 to February week 4, 2012) and EMBASE (January 1974 to February 2012). SELECTION CRITERIA Randomised controlled trials (RCTs) of antibiotics versus placebo in participants with rhinosinusitis-like signs or symptoms. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed the risk of bias. We contacted trial authors for additional information. We collected information on adverse effects from the trials. MAIN RESULTS We included 10 trials involving 2450 participants. Overall, the risk of bias in these studies was low. Irrespective of the treatment group, 47% of participants were cured after one week and 71% after 14 days. Antibiotics can shorten the time to cure, but only five more participants per 100 will cure faster at any time point between 7 and 14 days if they receive antibiotics instead of placebo (number needed to treat to benefit (NNTB)) 18 (95% confidence interval (CI) 10 to 115, I(2) statistic 0%, eight trials). Purulent secretion resolves faster with antibiotics (odds ratio (OR) 1.58 (95% CI 1.13 to 2.22)), (NNTB 11, 95% CI 6 to 51, I(2) statistic 0%, three trials). However, 27% of the participants who received antibiotics and 15% of those who received placebo experienced adverse events (OR 2.10, 95% CI 1.60 to 2.77) (number needed to treat to harm (NNTH)) 8 (95% CI 6 to 13, I(2) statistic 13%, seven trials). More participants in the placebo group needed to start antibiotic therapy because of an abnormal course of rhinosinusitis (OR 0.49, 95% CI 0.36 to 0.66), NNTH 20 (95% CI 14 to 35, I(2) statistic 0%, eight trials). Only one disease-related complication (brain abscess) occurred in a patient treated with antibiotics. AUTHORS' CONCLUSIONS The potential benefit of antibiotics in the treatment of clinically diagnosed acute rhinosinusitis needs to be seen in the context of a high prevalence of adverse events. Taking into account antibiotic resistance and the very low incidence of serious complications, we conclude that there is no place for antibiotics for the patient with clinically diagnosed, uncomplicated acute rhinosinusitis. This review cannot make recommendations for children, patients with a suppressed immune system and patients with severe disease, as these populations were not included in the available trials.
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Affiliation(s)
- Marieke B Lemiengre
- Department of General Practice and Primary Health Care, Ghent University, Ghent, Belgium.
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22
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[Rhinosinusitis guidelines--unabridged version: S2 guidelines from the German Society of Otorhinolaryngology, Head and Neck Surgery]. HNO 2012; 60:141-62. [PMID: 22139025 DOI: 10.1007/s00106-011-2396-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Hayward G, Heneghan C, Perera R, Thompson M. Intranasal corticosteroids in management of acute sinusitis: a systematic review and meta-analysis. Ann Fam Med 2012; 10:241-9. [PMID: 22585889 PMCID: PMC3354974 DOI: 10.1370/afm.1338] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Acute sinusitis is a common condition in ambulatory care, where it is frequently treated with antibiotics, despite little evidence of their benefit. Intranasal corticosteroids might relieve symptoms; however, evidence for this benefit is currently unclear. We performed a systematic review and meta-analysis of the effects of intranasal corticosteroids on the symptoms of acute sinusitis. METHODS We searched MEDLINE, EMBASE, the Cochrane Central register of Controlled Trials (CENTRAL), and Centre for Reviews and Dissemination databases until February 2011 for studies comparing intranasal corticosteroids with placebo in children or adults having clinical symptoms and signs of acute sinusitis or rhinosinusitis in ambulatory settings. We excluded chronic/allergic sinusitis. Two authors independently extracted data and assessed the studies' methodologic quality. RESULTS We included 6 studies having a total of 2,495 patients. In 5 studies, antibiotics were prescribed in addition to corticosteroids or placebo. Intranasal corticosteroids resulted in a significant, small increase in resolution of or improvement in symptoms at days 14 to 21 (risk difference [RD] = 0.08; 95% CI, 0.03-0.13). Analysis of individual symptom scores revealed most consistently significant benefits for facial pain and congestion. Subgroup analysis by time of reported outcomes showed a significant beneficial effect at 21 days (RD = 0.11; 95% CI, 0.06-0.17), but not at 14 to 15 days (RD = 0.05; 95% CI, -0.01 to 0.11). Meta-regression analysis of trials using different doses of mometasone furoate showed a significant dose-response relationship (P=.02). CONCLUSIONS Intranasal corticosteroids offer a small therapeutic benefit in acute sinusitis, which may be greater with high doses and with courses of 21 days' duration. Further trials are needed in antibiotic-naïve patients.
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Affiliation(s)
- Gail Hayward
- Department of Primary Care Health Sciences, Oxford University, Oxford, England, UK.
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Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJC, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. Clin Infect Dis 2012. [DOI: 10.1093/cid/cis370] [Citation(s) in RCA: 367] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Evidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, and empiric antimicrobial and adjunctive therapy were developed.
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Affiliation(s)
- Anthony W. Chow
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Itzhak Brook
- Department of Pediatrics, Georgetown University School of Medicine, Washington, D.C
| | - Jan L. Brozek
- Department of Clinical Epidemiology and Biostatistics
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ellie J. C. Goldstein
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles
- R. M. Alden Research Laboratory, Santa Monica, California
| | - Lauri A. Hicks
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - George A. Pankey
- Department of Infectious Disease Research, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Mitchel Seleznick
- Division of General Internal Medicine, University of South Florida College of Medicine, Tampa
| | - Gregory Volturo
- Department of Emergency Medicine, University of Massachusetts, Worcester
| | - Ellen R. Wald
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Thomas M. File
- Department of Infectious Diseases, Northeast Ohio Medical University, Rootstown
- Summa Health System, Akron, Ohio
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Desrosiers M, Evans GA, Keith PK, Wright ED, Kaplan A, Bouchard J, Ciavarella A, Doyle PW, Javer AR, Leith ES, Mukherji A, Schellenberg RR, Small P, Witterick IJ. Canadian clinical practice guidelines for acute and chronic rhinosinusitis. Allergy Asthma Clin Immunol 2011; 7:2. [PMID: 21310056 PMCID: PMC3055847 DOI: 10.1186/1710-1492-7-2] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 02/10/2011] [Indexed: 01/26/2023] Open
Abstract
This document provides healthcare practitioners with information regarding the management of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) to enable them to better meet the needs of this patient population. These guidelines describe controversies in the management of acute bacterial rhinosinusitis (ABRS) and include recommendations that take into account changes in the bacteriologic landscape. Recent guidelines in ABRS have been released by American and European groups as recently as 2007, but these are either limited in their coverage of the subject of CRS, do not follow an evidence-based strategy, or omit relevant stakeholders in guidelines development, and do not address the particulars of the Canadian healthcare environment. Advances in understanding the pathophysiology of CRS, along with the development of appropriate therapeutic strategies, have improved outcomes for patients with CRS. CRS now affects large numbers of patients globally and primary care practitioners are confronted by this disease on a daily basis. Although initially considered a chronic bacterial infection, CRS is now recognized as having multiple distinct components (eg, infection, inflammation), which have led to changes in therapeutic approaches (eg, increased use of corticosteroids). The role of bacteria in the persistence of chronic infections, and the roles of surgical and medical management are evolving. Although evidence is limited, guidance for managing patients with CRS would help practitioners less experienced in this area offer rational care. It is no longer reasonable to manage CRS as a prolonged version of ARS, but rather, specific therapeutic strategies adapted to pathogenesis must be developed and diffused. Guidelines must take into account all available evidence and incorporate these in an unbiased fashion into management recommendations based on the quality of evidence, therapeutic benefit, and risks incurred. This document is focused on readability rather than completeness, yet covers relevant information, offers summaries of areas where considerable evidence exists, and provides recommendations with an assessment of strength of the evidence base and degree of endorsement by the multidisciplinary expert group preparing the document. These guidelines have been copublished in both Allergy, Asthma & Clinical Immunology and the Journal of Otolaryngology-Head and Neck Surgery.
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Affiliation(s)
- Martin Desrosiers
- Division of Otolaryngology - Head and Neck Surgery Centre Hospitalier de l'Université de Montréal, Université de Montréal Hotel-Dieu de Montreal, and Department of Otolaryngology - Head and Neck Surgery and Allergy, Montreal General Hospital, McGill University, Montreal, QC, Canada.
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Bucca CB, Bugiani M, Culla B, Guida G, Heffler E, Mietta S, Moretto A, Rolla G, Brussino L. Chronic cough and irritable larynx. J Allergy Clin Immunol 2010; 127:412-9. [PMID: 21167571 DOI: 10.1016/j.jaci.2010.10.038] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 10/10/2010] [Accepted: 10/27/2010] [Indexed: 01/29/2023]
Abstract
BACKGROUND Perennial rhinitis (PR), chronic rhinosinusitis (CRS), or both, asthma, and gastroesophageal reflux disease (GERD) are the most frequent triggers of chronic cough (CC). Extrathoracic airway receptors might be involved in all 3 conditions because asthma is often associated with PR/CRS and gastroesophageal refluxate might reach the upper airway. We previously found that most patients with rhinosinusitis, postnasal drip, and pharyngolaryngitis show laryngeal hyperresponsiveness (LHR; ie, vocal cord adduction on histamine challenge) that is consistent with an irritable larynx. OBJECTIVE We sought to evaluate the role of LHR in patients with CC. METHODS LHR and bronchial hyperresponsiveness (BHR) to histamine were assessed in 372 patients with CC and in 52 asthmatic control subjects without cough (asthma/CC-). In 172 patients the challenge was repeated after treatment for the underlying cause of cough. RESULTS The primary trigger of CC was PR/CRS in 208 (56%) patients, asthma in 41 (11%) patients (asthma/CC+), GERD in 62 (17%) patients, and unexplained chronic cough (UNEX) in 61 (16%) patients. LHR prevalence was 76% in patients with PR/CRS, 77% in patients with GERD, 66% in patients with UNEX, 93% in asthma/CC+ patients, and 11% in asthma/CC- patients. Upper airway disease was found in most (95%) asthma/CC+ patients and in 6% of asthma/CC- patients. BHR discriminated asthmatic patients and atopy discriminated patients with PR/CRS from patients with GERD and UNEX. Absence of LHR discriminated asthmatic patients without cough. After treatment, LHR resolved in 63% of the patients and improved in 11%, and BHR resolved in 57% and improved in 18%. CONCLUSIONS An irritable larynx is common in patients with CC and indicates upper airway involvement, whether from rhinitis/sinusitis, gastric reflux, or idiopathic sensory neuropathy.
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Affiliation(s)
- Caterina B Bucca
- Department of Clinical Pathophysiology, University of Turin, Turin, Italy.
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27
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Rosenfeld RM, Shiffman RN. Clinical practice guideline development manual: a quality-driven approach for translating evidence into action. Otolaryngol Head Neck Surg 2009; 140:S1-43. [PMID: 19464525 DOI: 10.1016/j.otohns.2009.04.015] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 04/20/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND Guidelines translate best evidence into best practice. A well-crafted guideline promotes quality by reducing health-care variations, improving diagnostic accuracy, promoting effective therapy, and discouraging ineffective-or potentially harmful-interventions. Despite a plethora of published guidelines, methodology is often poorly defined and varies greatly within and among organizations. PURPOSE This manual describes the principles and practices used successfully by the American Academy of Otolaryngology-Head and Neck Surgery to produce quality-driven, evidence-based guidelines using efficient and transparent methodology for action-ready recommendations with multidisciplinary applicability. The development process, which allows moving from conception to completion in 12 months, emphasizes a logical sequence of key action statements supported by amplifying text, evidence profiles, and recommendation grades that link action to evidence. CONCLUSIONS As clinical practice guidelines become more prominent as a key metric of quality health care, organizations must develop efficient production strategies that balance rigor and pragmatism. Equally important, clinicians must become savvy in understanding what guidelines are-and are not-and how they are best utilized to improve care. The information in this manual should help clinicians and organizations achieve these goals.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, State University of New York Downstate, NY, USA.
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Affiliation(s)
- Richard M. Rosenfeld
- Otolaryngology—Head and Neck Surgery, Department of Otolaryngology, State University of New York Downstate, and Long Island College Hospital, Brooklyn, NY
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Siempos II, Dimopoulos G, Falagas ME. Meta-analyses on the Prevention and Treatment of Respiratory Tract Infections. Infect Dis Clin North Am 2009; 23:331-53. [DOI: 10.1016/j.idc.2009.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Timko J. Changes in antibiotic resistance of respiratory pathogens in the Slovak Republic. Eur Arch Otorhinolaryngol 2009; 266:1563-7. [PMID: 19343357 DOI: 10.1007/s00405-009-0971-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 03/20/2009] [Indexed: 11/26/2022]
Abstract
Respiratory tract infections are one of the most common reasons for public sickness rate. Even though they are usually virus-caused, antibiotic prescription is mostly used in primary care. The increase of resistance of bacterial strains observed in the last decade has much to do with this. This increase is connected mainly with the increasing antibiotics consumption and their selective pressure. That is why in many countries, there is an effort to stop this increase by reducing the useless prescription from etiology point of view. This paper points out a more careful approach to acute bacterial rhinosinusitis treatment in the community, taking into consideration the worsening condition of antibiotics resistance in Slovakia and Europe.
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Affiliation(s)
- Jaroslav Timko
- Department of Clinical Microbiology, Central Military Hospital, 03426, Ruzomberok, Slovakia.
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31
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2008; 16:292-5. [DOI: 10.1097/moo.0b013e3283041256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ahovuo-Saloranta A, Borisenko OV, Kovanen N, Varonen H, Rautakorpi UM, Williams JW, Mäkelä M. Antibiotics for acute maxillary sinusitis. Cochrane Database Syst Rev 2008:CD000243. [PMID: 18425861 DOI: 10.1002/14651858.cd000243.pub2] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Expert opinions vary on the appropriate role of antibiotics for sinusitis, one of the most commonly diagnosed conditions among adults in ambulatory care. OBJECTIVES We examined whether antibiotics are effective in treating acute sinusitis, and if so, which antibiotic classes are the most effective. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2007, Issue 3); MEDLINE (1950 to May 2007) and EMBASE (1974 to June 2007). SELECTION CRITERIA Randomized controlled trials (RCTs) comparing antibiotics with placebo or antibiotics from different classes for acute maxillary sinusitis in adults. We included trials with clinically diagnosed acute sinusitis, whether or not confirmed by radiography or bacterial culture. DATA COLLECTION AND ANALYSIS At least two review authors independently screened search results, extracted data and quality assessed trials. Risk ratios (RR) were calculated for differences in the intervention and control groups to see whether or not the treatment was a failure. In meta-analysing the placebo-controlled studies, the data across antibiotic classes were combined. Primary outcomes were the clinical failure rates at 7 to 15 days and 16 to 60 days follow up. MAIN RESULTS Fifty-seven studies were included in the review; six placebo-controlled studies and 51 studies comparing different classes of antibiotics. Five studies involving 631 participants provided data for comparison of antibiotics to placebo, when clinical failure was defined as a lack of cure or improvement at 7 to 15 days follow up. These studies found a slight statistical difference in favor of antibiotics, compared to placebo, with a pooled RR of 0.66 (95% confidence interval (CI) 0.44 to 0.98). However, the clinical significance of the result is equivocal, also considering that cure or improvement rate was high in both the placebo group (80%) and the antibiotic group (90%). Based on six studies, when clinical failure was defined as a lack of total cure, there was significant difference in favor of antibiotics compared to placebo with a pooled RR of 0.74 (95% CI 0.65 to 0.84) at 7 to 15 days follow up. None of the antibiotic preparations was superior to each other. AUTHORS' CONCLUSIONS Antibiotics have a small treatment effect in patients with uncomplicated acute sinusitis in a primary care setting with symptoms for more than seven days. However, 80% of participants treated without antibiotics improve within two weeks. Clinicians need to weigh the small benefits of antibiotic treatment against the potential for adverse effects at both the individual and general population level.
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Affiliation(s)
- Anneli Ahovuo-Saloranta
- Finnish Office for Health Technology Assessment / FinOHTA, National Research and Development Centre for Welfare & Health / STAKES, Finn-Medi 3, Biokatu 10, Tampere, Finland, 33520
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Le Saux N. The treatment of acute bacterial sinusitis: no change is good medicine. CMAJ 2008; 178:865-6. [PMID: 18362382 DOI: 10.1503/cmaj.080285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Nicole Le Saux
- Department of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, Ont.
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Young J, De Sutter A, Merenstein D, van Essen GA, Kaiser L, Varonen H, Williamson I, Bucher HC. Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. Lancet 2008; 371:908-14. [PMID: 18342685 DOI: 10.1016/s0140-6736(08)60416-x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Primary-care physicians continue to overprescribe antibiotics for acute rhinosinusitis because distinction between viral and bacterial sinus infection is difficult. We undertook a meta-analysis of randomised trials based on individual patients' data to assess whether common signs and symptoms can be used to identify a subgroup of patients who benefit from antibiotics. METHODS We identified suitable trials--in which adult patients with rhinosinusitis-like complaints were randomly assigned to treatment with an antibiotic or a placebo--by searching the Cochrane Central Register of Controlled Trials, Medline, and Embase, and reference lists of reports describing such trials. Individual patients' data from 2547 adults in nine trials were checked and re-analysed. We assessed the overall effect of antibiotic treatment and the prognostic value of common signs and symptoms by the number needed to treat (NNT) with antibiotics to cure one additional patient. FINDINGS 15 patients with rhinosinusitis-like complaints would have to be given antibiotics before an additional patient was cured (95% CI NNT[benefit] 7 to NNT[harm] 190). Patients with purulent discharge in the pharynx took longer to cure than those without this sign; the NNT was 8 patients with this sign before one additional patient was cured (95% CI NNT[benefit] 4 to NNT[harm] 47). Patients who were older, reported symptoms for longer, or reported more severe symptoms also took longer to cure but were no more likely to benefit from antibiotics than other patients. INTERPRETATION Common clinical signs and symptoms cannot identify patients with rhinosinusitis for whom treatment is clearly justified. Antibiotics are not justified even if a patient reports symptoms for longer than 7-10 days.
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Affiliation(s)
- Jim Young
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Basel, Switzerland.
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Affiliation(s)
- Morten Lindbaek
- Antibiotic Centre for Primary Care, University of Oslo, Blindern 0317 Oslo, Norway.
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Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, Gelzer A, Hamilos D, Haydon RC, Hudgins PA, Jones S, Krouse HJ, Lee LH, Mahoney MC, Marple BF, Mitchell CJP, Nathan R, Shiffman RN, Smith TL, Witsell DL. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg 2007; 137:S1-31. [PMID: 17761281 DOI: 10.1016/j.otohns.2007.06.726] [Citation(s) in RCA: 626] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2007] [Revised: 06/20/2007] [Accepted: 06/20/2007] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This guideline provides evidence-based recommendations on managing sinusitis, defined as symptomatic inflammation of the paranasal sinuses. Sinusitis affects 1 in 7 adults in the United States, resulting in about 31 million individuals diagnosed each year. Since sinusitis almost always involves the nasal cavity, the term rhinosinusitis is preferred. The guideline target patient is aged 18 years or older with uncomplicated rhinosinusitis, evaluated in any setting in which an adult with rhinosinusitis would be identified, monitored, or managed. This guideline is intended for all clinicians who are likely to diagnose and manage adults with sinusitis. PURPOSE The primary purpose of this guideline is to improve diagnostic accuracy for adult rhinosinusitis, reduce inappropriate antibiotic use, reduce inappropriate use of radiographic imaging, and promote appropriate use of ancillary tests that include nasal endoscopy, computed tomography, and testing for allergy and immune function. In creating this guideline the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of allergy, emergency medicine, family medicine, health insurance, immunology, infectious disease, internal medicine, medical informatics, nursing, otolaryngology-head and neck surgery, pulmonology, and radiology. RESULTS The panel made strong recommendations that 1) clinicians should distinguish presumed acute bacterial rhinosinusitis (ABRS) from acute rhinosinusitis caused by viral upper respiratory infections and noninfectious conditions, and a clinician should diagnose ABRS when (a) symptoms or signs of acute rhinosinusitis are present 10 days or more beyond the onset of upper respiratory symptoms, or (b) symptoms or signs of acute rhinosinusitis worsen within 10 days after an initial improvement (double worsening), and 2) the management of ABRS should include an assessment of pain, with analgesic treatment based on the severity of pain. The panel made a recommendation against radiographic imaging for patients who meet diagnostic criteria for acute rhinosinusitis, unless a complication or alternative diagnosis is suspected. The panel made recommendations that 1) if a decision is made to treat ABRS with an antibiotic agent, the clinician should prescribe amoxicillin as first-line therapy for most adults, 2) if the patient worsens or fails to improve with the initial management option by 7 days, the clinician should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications, 3) clinicians should distinguish chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis from isolated episodes of ABRS and other causes of sinonasal symptoms, 4) clinicians should assess the patient with CRS or recurrent acute rhinosinusitis for factors that modify management, such as allergic rhinitis, cystic fibrosis, immunocompromised state, ciliary dyskinesia, and anatomic variation, 5) the clinician should corroborate a diagnosis and/or investigate for underlying causes of CRS and recurrent acute rhinosinusitis, 6) the clinician should obtain computed tomography of the paranasal sinuses in diagnosing or evaluating a patient with CRS or recurrent acute rhinosinusitis, and 7) clinicians should educate/counsel patients with CRS or recurrent acute rhinosinusitis regarding control measures. The panel offered as options that 1) clinicians may prescribe symptomatic relief in managing viral rhinosinusitis, 2) clinicians may prescribe symptomatic relief in managing ABRS, 3) observation without use of antibiotics is an option for selected adults with uncomplicated ABRS who have mild illness (mild pain and temperature <38.3 degrees C or 101 degrees F) and assurance of follow-up, 4) the clinician may obtain nasal endoscopy in diagnosing or evaluating a patient with CRS or recurrent acute rhinosinusitis, and 5) the clinician may obtain testing for allergy and immune function in evaluating a patient with CRS or recurrent acute rhinosinusitis. DISCLAIMER This clinical practice guideline is not intended as a sole source of guidance for managing adults with rhinosinusitis. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.
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Affiliation(s)
- Richard M Rosenfeld
- Department of Otolaryngology, SUNY Downstate Medical Center and Long Island College Hospital, Brooklyn, NY 11201-5514, USA.
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