抗生素PPT课件（英文精品）Antibiotics for URISinusitis A Simple Decision Gone .pptVIP

Spotlight Case April 2008 Antibiotics for URI/Sinusitis: A Simple Decision Gone Bad Source and Credits This presentation is based on the April 2008 AHRQ WebMM Spotlight Case See the full article at CME credit is available Commentary by: Sumant Ranji, MD, University of California, San Francisco School of Medicine Editor, AHRQ WebMM: Robert Wachter, MD Spotlight Editor: Tracy Minichiello, MD Managing Editor: Erin Hartman, MS Objectives At the conclusion of this educational activity, participants should be able to: Understand the indications for antibiotic treatment in acute sinusitis Recognize the potential harms of inappropriate antibiotic prescribing for individual patients and the population at large Review the evidence on the effectiveness of quality improvement efforts to reduce inappropriate antibiotic use Case: Antibiotics for URI A healthy 53-year-old woman presented to her primary care physician with upper respiratory symptoms and possible sinusitis. She was prescribed Augmentin [amoxicillin- clavulanate]. Despite this therapy, her symptoms persisted. She was then prescribed azithromycin. Upper Respiratory Tract Infections Most common presenting complaint to PCPs 83.1 million visits in 2002 3.1 million of these were acute sinusitis in adults Sinusitis occurs after or in conjunction with a viral upper respiratory tract infection Acute Sinusitis Most acute sinusitis caused by viruses Only 0.5%-2% of viral sinusitis develops into a bacterial infection Distinguishing viral from bacterial sinusitis on clinical grounds is difficult Typical symptoms do not reliably predict which type Imaging such as CT or X-ray can be abnormal in both viral and bacterial sinusitis CDC Recommendations Acute bacterial rhinosinusitis can be diagnosed only when a patient has 3 clinical criteria: Maxillary pain or tenderness in face or teeth Mucopurulent nasal discharge Symptoms have lasted for 7 days or more Additional Recommendations Worsening of symptoms after initial improve