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Diagnosis and treatment of acute sinusitis

The problem of diagnosis and treatment of acute and chronic infectious diseases of upper respiratory tract (rhinosinusitis, bacterial tonsillitis, adenoids, acute otitis and otogenic rhinogenous in ints intracranial and orbital complications) hasn’t lost its relevance, as evidenced by a high incidence of patients and complaints as admitted by general practitioners and otolaryngologists. The cases for chronic, protracted course of the disease, as well as the cases of the syndrome of systemic inflammation (SIRS - systemic inflammatory response syndrome) and the development of severe, life-threatening complications also pose a problem.

This problem is crucial not only in the ENT, but also in general medicine. Importantly, the majority of patients with acute inflammatory diseases of ENT organs often visit general practitioners with chronic inflammatory diseases of the mucous membrane of the nasal cavity and paranasal sinuses; these are the most common and hard-occurring pathological conditions of the upper respiratory tract, and acute otitis media is a leader in a number of non-invasive bacterial infections, especially in children. In addition, after the diagnostic and therapeutic manipulation in the oropharynx in 18-58% of cases bacteremia is observed, which is the causative agent of hemolytic streptococcus.

In accordance with the accumulated experience the effectiveness of the treatment of acute infectious and inflammatory diseases of ENT organs is largely defined by how promptly and efficiently systemic antibiotic therapy is carried out, since antibiotics are etiotropic drugs selectively inhibit the vital activity of the microbial flora and having specificity for causative agents of human infectious diseases.

Adequate use of active, fast, safe and easy to use antibacterial drugs can reduce the number of acute and, as a consequence, chronic infectious and inflammatory diseases of ENT organs and conduct an effective intraoperative and perioperative antibiotic prophylaxis of possible postoperative complications. In some cases, this makes it possible to abandon the traumatic invasive diagnostic method - puncture of the maxillary sinus puncture and tactics of treatment of sinusitis.

These provisions were convincing proof to a sufficiently large number of scientific and clinical research in recent years. The effectiveness of systemic antibiotic therapy significantly increases when a range of therapeutic measures is properly selected. For example, the combination of purulent inflammation in the paranasal sinuses with allergic or polypous process of conducting systemic antibiotics alone cannot achieve long-term remission or complete recovery. Clinically effective in this case, is the combination therapy using broad-spectrum antibiotics, mucolytics and drugs used for the treatment of allergic rhinosinusitis - topical glucocorticosteroids and H1 receptor blockers. The need for such a treatment strategy increases when combined polypous-purulent rhinosinusitis and asthma, because the successful treatment of diseases of the nose and paranasal sinuses provides improvement in the respiratory system. Combination therapy of patients with bacterial tonsillitis should reasonably include local immunocorrecting drugs and adaptogens. In acute otitis media, in addition to local therapy, the appointing mucolytics, antihistamines and analgesics is advisable.

The basis for successful management of etiopathogenetical-sound application of antimicrobial drugs is a detailed analysis of the ‘factors of the patient’ and ‘factors of infectious agents’. The core requirement for destination antibiotic is assessment of interaction between ‘patient (macroorganism) - pathogen (germ) and drug’, which means:

- Compliance with antimicrobial nature of the microbial flora and the range of sensitivity (growth ‘sensitive’ microorganisms stops when the required therapeutic drug concentrations in the blood is achieved)

- Compliance with the necessary requirements for the fence pathological material, which ensures the accuracy of the results of bacteriological research;

- The correct selection of the route of administration of the drug and its single and/or daily dose courses;

The analysis of the severity of the disease, immune status, allergic history, the state of the excretory, cardiovascular system, gastrointestinal tract, physiological and individual characteristics, the patient's age, tolerability and previous antimicrobial therapy are taken into account. Reporting of any possible side effects of the therapy is mandatory.

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