На всякий случай (мне самому интересно лечение синуситов, поскольку несколько раз в неделю я притворяюсь семейным врачом чтобы отдохнуть от тяжелого и дементного контингента) суммирую (суммирую не я, я публикую
):
SUMMARY AND RECOMMENDATIONS Acute rhinosinusitis (ARS), inflammation of the nasal cavity and paranasal sinuses lasting less than four weeks, is subdivided into acute viral rhinosinusitis (AVRS) and acute bacterial rhinosinsitis (ABRS). ABRS occurs in 0.5 to 2 percent of episodes. (See "Introduction" above and see "Pathophysiology" above). The diagnosis of ARS is based on the presence of 1) purulent rhinorrhea and 2) nasal congestion and/or facial pain. Symptoms do not accurately distinguish viral from bacterial infection. ABRS is suggested by the presence of symptoms for seven or more days, especially if symptoms initially improve and then worsen. Cultures from nasal swabs or secretions are inaccurate. Radiography is generally not indicated in the initial evaluation of ARS. (See "Diagnosis" above). AVRS is expected to resolve within ten days; ABRS may also resolve spontaneously within the first ten days. Patients who present with fewer than 10 days of symptoms, in the absence of high fever or symptoms suggesting complicated illness, should be managed with supportive care. We suggest mild analgesics, systemic or limited-duration topical decongestants, and fluid (Grade 2C). We suggest treatment with intranasal glucocorticoids (Grade 2B). We suggest not treating symptoms with antihistamines or zinc (Grade 2B). (See "Indications for urgent referral" above and see "Acute viral rhinosinusitis" above). We suggest that patients with mild symptoms lasting more than ten days be treated with observation and supportive therapy (as above) for an additional seven days (Grade 2C). (See "Observation" above). We suggest treatment with an antibiotic for patients with moderate to severe symptoms of ABRS (T >101, severe pain), or for patients whose symptoms worsen during observation (Grade 2B). We recommend a narrow spectrum antibiotic for empiric therapy (Grade 1A). Our preference is for amoxicillin 500 mg three times a day for 10 to 14 days; trimethoprim-sulfamethoxazole and macrolides are alternatives. We suggest topical glucocorticoids as adjunctive therapy (Grade 2B). (See "Antimicrobials" above and see "Topical glucocorticoids" above). Nosocomial ABRS is relatively common in patients with prolonged nasotracheal intubation, and often involves gram negative organisms. Nasal foreign bodies should be removed and patients treated with culture-directed antibiotic therapy. Immunosuppressed patients are at risk for acute fulminant invasive fungal rhinosinusitis; treatment involves endoscopic biopsy, emergency surgical debridement, and systemic antifungal therapy. (See "Nosocomial bacterial rhinosinusitis" above and see "Acute invasive fungal rhinosinusitis" above). Complications of ABRS occur rarely, and include orbital cellulitis, osteitis, and meningitis. (See "Complications" above).
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Я бы попросил опубликовать клинический случай пациента, требующего пункции. С историей болезни и снимком - обсудим предметно. Сейчас дискуссия превращается в свалку
