DGI:Rhinosinusitis/Therapie: Difference between revisions

Latest revision as of 18:04, 9 August 2021

Therapie

Akute Rhinosinusitis

Spontanheilungsraten von > 50% nach 1 Woche, 60-80% nach 2 Wochen, und über > 90% nach 4 Wochen

Wenn Patient:innen innerhalb von 7 Tagen erneut vorstellig werden kann, dann bei viraler wie auch bei bakterieller Rhinosinusitis rein symptomatische Therapie.

Symptomatische Therapie
- Kochsalzinhalationen
- Nasale Anwendung von Salzlösungen z. B. als hochvolumige (≥150 ml), iso- bis leicht hypertone Spülung

Medikamentöse Therapie
- Mukolytische/Sekretolytische Therapie
- Dekongestiva
- Analgetisch und antipyretisch

Bei Hinweisen für bakterielle Rhinosinusitis Benefit für Einsatz für antibiotische Therapie nicht gesichert. Ausnahme bei

Radiologischer Nachweis von Sekretspiegeln oder Totalverschattung der NNH
Schmerzen + erhöhtes CRP
Mikrobiologischer Nachweis positiv


Klinische Situation	Präferenz	Substanz	Dosierung	Dauer	Anpassungen	Kommentar
Bakterielle Rhinu-sinusitis	Therapie der Wahl	Amoxicillin	500 mg p.o. 3x/d	7-10d	-
Bakterielle Rhinu-sinusitis	Alternative	Amoxicillin/ Clavulansäure	875/125 mg p.o. 3x/d		-	Resistenz-lage Pneumo-kokken

Chirurgische Therapie
- Bei Einschränkungen der regulären Ventilation und Drainage
- Bei bakterieller Infektion und ungenügendem Ansprechen auf systemische Therapie

Chronische Rhinosinusitis

[2^[1], 10^[4]]

Symptomatische Therapie
- Kochsalzinhalationen
- Nasale Anwendung von Salzlösungen z. B. als hochvolumige (≥150 ml), iso- bis leicht hypertone Spülung

Medikamentöse Therapie
- Mukolytische/Sekretolytische Therapie
- Dekongestiva
- Analgetisch und antipyretisch
- Topische Kortikosteroide
Biologika (bei Versagen etablierter Therapieformen)
- Anti IgE-Antikörper (Omalizumab)
- Anti IL-5-Antikörper (Mepolizumab, Reslizumab)
Antibiotika Einsatz keine klare Evidenz
- Short-term Applikation
  - bei endoskopisch gewonnenem positivem Mibi Befund
- Long-term Applikation
  - Generell keine Empfehlung
  - Im Einzelfall
    - bei CRSsNP (Chronic rhinosinusitis without nasal polyps) Clarithromycin bei Versagen der Standardtherapie evaluieren
    - Bei CRScNP (Chronic rhinosinusitis with nasal polyps) im Falle einer Rezidiv-Polyposis Doxycyclin evaluieren

Chirurgische Therapie
- Mangelnde Symptombesserung nach einem suffizienten medikamentösen Therapieversuch
- Bei entzündlichen Komplikationen
  - Abszesse
  - Orbitaödem
  - Endokranielle Komplikationen
  - Osteomyelitis im Bereich des Schädelknochens

↑ ^1.0 ^1.1 Stuck BA, Bachert C, Federspil P, et al. [Rhinosinusitis guidelines of the German Society for Otorhinolaryngology, Head and Neck Surgery]. HNO. 2007;55(10):758-760, 762-764, 766-777. doi:10.1007/s00106-007-1589-6
↑ Sinusitis and antibiotics - PubMed. Accessed July 9, 2021. https://pubmed.ncbi.nlm.nih.gov/22541622/
↑ Patel, Z.M. Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment. 2020; Available from: https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment.
↑ Sedaghat AR. Chronic Rhinosinusitis. Am Fam Physician. 2017;96(8):500-506.

[:0-1] 1.0 ^1.1 Stuck BA, Bachert C, Federspil P, et al. [Rhinosinusitis guidelines of the German Society for Otorhinolaryngology, Head and Neck Surgery]. HNO. 2007;55(10):758-760, 762-764, 766-777. doi:10.1007/s00106-007-1589-6

[2] Sinusitis and antibiotics - PubMed. Accessed July 9, 2021. https://pubmed.ncbi.nlm.nih.gov/22541622/

[3] Patel, Z.M. Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment. 2020; Available from: https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment.

[4] Sedaghat AR. Chronic Rhinosinusitis. Am Fam Physician. 2017;96(8):500-506.

[1]

[2]

[3]

[4]

@@ Line 2: / Line 2: @@
 ====Akute Rhinosinusitis====
-<span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">[2</span><ref><span style="font-size:11.0pt;line-height:107%;
+<span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">[2</span><ref name=":0">Stuck BA, Bachert C, Federspil P, et al. [Rhinosinusitis guidelines of the German Society for Otorhinolaryngology, Head and Neck Surgery]. HNO. 2007;55(10):758-760, 762-764, 766-777. doi:10.1007/s00106-007-1589-6</ref><span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">, 5</span><ref>Sinusitis and antibiotics - PubMed. Accessed July 9, 2021. <nowiki>https://pubmed.ncbi.nlm.nih.gov/22541622/</nowiki></ref><span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">- 8</span><ref>Patel, Z.M. Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment. 2020; Available from: <nowiki>https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment</nowiki>.</ref><span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">]</span>
-font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:
-Calibri;mso-fareast-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;
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-mso-ansi-language:DE;mso-fareast-language:EN-US;mso-bidi-language:AR-SA">Stuck, B.A., et al., ''[Rhinosinusitis guidelines of the German Society for Otorhinolaryngology, Head and Neck Surgery].'' HNO, 2007. '''55'''(10): p. 758-60, 762-4, 766-77.</span></ref><span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">, 5</span><ref>''<span style="font-size:11.0pt;line-height:107%;font-family:&quot;Calibri&quot;,sans-serif;
-mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
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-mso-bidi-theme-font:minor-bidi;mso-ansi-language:DE;mso-fareast-language:EN-US;
-mso-bidi-language:AR-SA">Sinusitis and antibiotics.</span>'' <span style="font-size:11.0pt;line-height:107%;font-family:&quot;Calibri&quot;,sans-serif;
-mso-ascii-theme-font:minor-latin;mso-fareast-font-family:Calibri;mso-fareast-theme-font:
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-mso-bidi-theme-font:minor-bidi;mso-ansi-language:DE;mso-fareast-language:EN-US;
-mso-bidi-language:AR-SA">Lancet Infect Dis, 2012. '''12'''(5): p. 355.</span><br /></ref><span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">- 8</span><ref>Patel, Z.M. ''Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment''. 2020; Available from: https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment.</ref><span style="font-size:12.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif">]</span>
 <span style="font-family:&quot;Arial&quot;,sans-serif">Spontanheilungsraten von > 50% nach 1 Woche, 60-80% nach 2 Wochen, und über > 90% nach 4 Wochen</span>
@@ Line 38: / Line 26: @@
-<br />
 {| class="wikitable sortable filterable MsoTableGrid" style="margin-left:-.25pt;border-collapse:collapse;mso-table-layout-alt:fixed;" width="605" cellspacing="0" cellpadding="0" border="1"
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 | style="width:63.75pt;" width="85" valign="top" |'''<span style="color: black">Kommentar</span>'''
 |- style="height:27.7ptpx;"
-| rowspan="3" style="width:63.8pt;" width="85" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
+| rowspan="2" style="width:63.8pt;" width="85" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
    Arial">Bakterielle Rhinu-sinusitis</span>
-| rowspan="2" style="width:63.8pt;" width="85" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
+| style="width:63.8pt;" width="85" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
    Arial">Therapie der Wahl</span>
 | style="width:3.0cm;" width="113" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
@@ Line 62: / Line 48: @@
 | style="width:53.35pt;" width="71" valign="top" |<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:
    Arial">-</span>
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-|- style="height:21.05ptpx;"
-| style="width:3.0cm;" width="113" valign="top" |
-| style="width:80.7pt;" width="108" valign="top" |
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-| style="width:53.35pt;" width="71" valign="top" |
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@@ Line 89: / Line 69: @@
 ====Chronische Rhinosinusitis====
-[2<ref><span style="font-size:11.0pt;line-height:107%;
+[2<ref name=":0" />, 10<ref>Sedaghat AR. Chronic Rhinosinusitis. Am Fam Physician. 2017;96(8):500-506.</ref>]<br />
-font-family:&quot;Calibri&quot;,sans-serif;mso-ascii-theme-font:minor-latin;mso-fareast-font-family:
-Calibri;mso-fareast-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;
-mso-bidi-font-family:&quot;Times New Roman&quot;;mso-bidi-theme-font:minor-bidi;
-mso-ansi-language:DE;mso-fareast-language:EN-US;mso-bidi-language:AR-SA">Stuck, B.A., et al., ''[Rhinosinusitis guidelines of the German Society for Otorhinolaryngology, Head and Neck Surgery].'' HNO, 2007. '''55'''(10): p. 758-60, 762-4, 766-77.</span></ref>, 10<ref>Sedaghat, A.R., ''Chronic Rhinosinusitis.'' Am Fam Physician, 2017. '''96'''(8): p. 500-506.</ref>]<br />
 *<span style="font-family:&quot;Arial&quot;,sans-serif">Symptomatische Therapie</span>
 **<span style="font-family:&quot;Arial&quot;,sans-serif">Kochsalzinhalationen</span>
-**<span style="color: black">nasale Anwendung von Salzlösungen z. B. als hochvolumige (≥150 ml), iso- bis leicht hypertone Spülung </span>
+**<span style="color: black">Nasale Anwendung von Salzlösungen z. B. als hochvolumige (≥150 ml), iso- bis leicht hypertone Spülung </span>
-*<span style="color: black">medikamentöse Therapie</span>
+*<span style="color: black">Medikamentöse Therapie</span>
 **<span style="font-family:&quot;Arial&quot;,sans-serif">Mukolytische/Sekretolytische Therapie</span>
 **<span style="font-family:&quot;Arial&quot;,sans-serif">Dekongestiva</span>
@@ Line 117: / Line 93: @@
 *<span style="font-family:&quot;Arial&quot;,sans-serif; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-language:DE">Chirurgische Therapie</span>
-**<span style="font-family:&quot;Arial&quot;,sans-serif">mangelnde Symptombesserung nach einem suffizienten medikamentösen Therapieversuch</span>
+**<span style="font-family:&quot;Arial&quot;,sans-serif">Mangelnde Symptombesserung nach einem suffizienten medikamentösen Therapieversuch</span>
-**<span style="font-family:&quot;Arial&quot;,sans-serif; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-language:DE">bei entzündlichen Komplikationen</span>
+**<span style="font-family:&quot;Arial&quot;,sans-serif; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-language:DE">Bei entzündlichen Komplikationen</span>
 ***<span style="font-family:&quot;Arial&quot;,sans-serif;mso-fareast-font-family:&quot;Times New Roman&quot;; mso-fareast-language:DE">Abszesse</span>
 ***<span style="font-family:&quot;Arial&quot;,sans-serif; mso-fareast-font-family:&quot;Times New Roman&quot;;mso-fareast-language:DE">Orbitaödem</span>
@@ Line 125: / Line 101: @@
 <br />
-<references />