DGI:Rhinosinusitis/Therapie: Difference between revisions
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== Therapie == | ==Therapie== | ||
==== Akute Rhinosinusitis '''<span style="font-size:12.0pt;line-height:107%;font-family:"Arial",sans-serif">[2</span>'''<ref><span style="font-size:11.0pt;line-height:107%; | ====Akute Rhinosinusitis ==== | ||
'''<span style="font-size:12.0pt;line-height:107%;font-family:"Arial",sans-serif">[2</span>'''<ref><span style="font-size:11.0pt;line-height:107%; | |||
font-family:"Calibri",sans-serif;mso-ascii-theme-font:minor-latin;mso-fareast-font-family: | font-family:"Calibri",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; | Calibri;mso-fareast-theme-font:minor-latin;mso-hansi-theme-font:minor-latin; | ||
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minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:"Times New Roman"; | minor-latin;mso-hansi-theme-font:minor-latin;mso-bidi-font-family:"Times New Roman"; | ||
mso-bidi-theme-font:minor-bidi;mso-ansi-language:DE;mso-fareast-language:EN-US; | 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:"Arial",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:"Arial",sans-serif">]</span>''' | 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:"Arial",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:"Arial",sans-serif">]</span>''' | ||
<span style="font-family:"Arial",sans-serif">Spontanheilungsraten von > 50% nach 1 Woche, 60-80% nach 2 Wochen, und über > 90% nach 4 Wochen</span> | <span style="font-family:"Arial",sans-serif">Spontanheilungsraten von > 50% nach 1 Woche, 60-80% nach 2 Wochen, und über > 90% nach 4 Wochen</span> | ||
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<br /> | <br /> | ||
* <span style="font-family:"Arial",sans-serif">Symptomatische Therapie</span> | *<span style="font-family:"Arial",sans-serif">Symptomatische Therapie</span> | ||
** <span style="font-family:"Arial",sans-serif">Kochsalzinhalationen</span> | **<span style="font-family:"Arial",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:"Arial",sans-serif">Mukolytische/Sekretolytische Therapie</span> | **<span style="font-family:"Arial",sans-serif">Mukolytische/Sekretolytische Therapie</span> | ||
** <span style="font-family:"Arial",sans-serif">Dekongestiva</span> | **<span style="font-family:"Arial",sans-serif">Dekongestiva</span> | ||
** <span style="font-family:"Arial",sans-serif">Analgetisch und antipyretisch</span> | **<span style="font-family:"Arial",sans-serif">Analgetisch und antipyretisch</span> | ||
<span style="font-family:"Arial",sans-serif">Bei Hinweisen für bakterielle Rhinosinusitis Benefit für Einsatz für antibiotische Therapie nicht gesichert. Ausnahme bei</span> | <span style="font-family:"Arial",sans-serif">Bei Hinweisen für bakterielle Rhinosinusitis Benefit für Einsatz für antibiotische Therapie nicht gesichert. Ausnahme bei</span> | ||
* <span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman""> </span></span></span><span style="font-family:"Arial",sans-serif">Radiologischer Nachweis von Sekretspiegeln oder Totalverschattung der NNH</span> | *<span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family: Symbol"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman""> </span></span></span><span style="font-family:"Arial",sans-serif">Radiologischer Nachweis von Sekretspiegeln oder Totalverschattung der NNH</span> | ||
* <span style="font-family:"Arial",sans-serif">Schmerzen + erhöhtes CRP</span> | *<span style="font-family:"Arial",sans-serif">Schmerzen + erhöhtes CRP</span> | ||
* <span style="font-family:"Arial",sans-serif">Mikrobiologischer Nachweis positiv</span> | *<span style="font-family:"Arial",sans-serif">Mikrobiologischer Nachweis positiv</span> | ||
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| style="width:63.8pt;" width="85" valign="top" |'''<span style="font-family:"Arial",sans-serif;mso-fareast-font-family:Arial">Klinische Situation</span>''' | | style="width:63.8pt;" width="85" valign="top" |'''<span style="font-family:"Arial",sans-serif;mso-fareast-font-family:Arial">Klinische Situation</span>''' | ||
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<br /> | <br /> | ||
* | *<span style="font-family:Symbol;mso-fareast-font-family: Symbol;mso-bidi-font-family:Symbol"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman""> </span></span></span><span style="font-family:"Arial",sans-serif">Chirurgische Therapie</span> | ||
** <span style="font-family:"Arial",sans-serif">Bei Einschränkungen der regulären Ventilation und Drainage</span> | **<span style="font-family:"Arial",sans-serif">Bei Einschränkungen der regulären Ventilation und Drainage</span> | ||
** <span style="font-family:"Arial",sans-serif">Bei bakterieller Infektion und ungenügendem Ansprechen auf systemische Therapie</span> | **<span style="font-family:"Arial",sans-serif">Bei bakterieller Infektion und ungenügendem Ansprechen auf systemische Therapie</span> | ||
==== Chronische Rhinosinusitis [2<ref><span style="font-size:11.0pt;line-height:107%; | ====Chronische Rhinosinusitis ==== | ||
[2<ref><span style="font-size:11.0pt;line-height:107%; | |||
font-family:"Calibri",sans-serif;mso-ascii-theme-font:minor-latin;mso-fareast-font-family: | font-family:"Calibri",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; | Calibri;mso-fareast-theme-font:minor-latin;mso-hansi-theme-font:minor-latin; | ||
mso-bidi-font-family:"Times New Roman";mso-bidi-theme-font:minor-bidi; | mso-bidi-font-family:"Times New Roman";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>] | 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 /> | ||
<br /> | |||
* <span style="font-family:"Arial",sans-serif">Symptomatische Therapie</span> | *<span style="font-family:"Arial",sans-serif">Symptomatische Therapie</span> | ||
** <span style="font-family:"Arial",sans-serif">Kochsalzinhalationen</span> | **<span style="font-family:"Arial",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">medikamentöse Therapie</span> | *<span style="color: black">medikamentöse Therapie</span> | ||
** <span style="font-family:"Arial",sans-serif">Mukolytische/Sekretolytische Therapie</span> | **<span style="font-family:"Arial",sans-serif">Mukolytische/Sekretolytische Therapie</span> | ||
** <span style="font-family:"Arial",sans-serif">Dekongestiva</span> | **<span style="font-family:"Arial",sans-serif">Dekongestiva</span> | ||
** <span style="font-family:"Arial",sans-serif">Analgetisch und antipyretisch</span> | **<span style="font-family:"Arial",sans-serif">Analgetisch und antipyretisch</span> | ||
** <span style="font-family:"Arial",sans-serif">Topische Kortikosteroide</span> | **<span style="font-family:"Arial",sans-serif">Topische Kortikosteroide</span> | ||
* <span style="font-family:Symbol; mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman""> </span></span></span><span style="font-family:"Arial",sans-serif">Biologika (bei Versagen etablierter Therapieformen)</span> | *<span style="font-family:Symbol; mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol"><span style="mso-list:Ignore"><span style="font:7.0pt "Times New Roman""> </span></span></span><span style="font-family:"Arial",sans-serif">Biologika (bei Versagen etablierter Therapieformen)</span> | ||
** <span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Anti IgE-Antikörper (Omalizumab)</span> | **<span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Anti IgE-Antikörper (Omalizumab)</span> | ||
** <span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Anti IL-5-Antikörper (Mepolizumab, Reslizumab)</span> | **<span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Anti IL-5-Antikörper (Mepolizumab, Reslizumab)</span> | ||
* <span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Antibiotika Einsatz keine klare Evidenz</span> | *<span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Antibiotika Einsatz keine klare Evidenz</span> | ||
** <span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Short-term Applikation</span> | **<span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Short-term Applikation</span> | ||
*** | ***<span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">bei endoskopisch gewonnenem positivem Mibi Befund</span> | ||
** <span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Long-term Applikation</span> | **<span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Long-term Applikation</span> | ||
*** <span style="font-family:"Arial",sans-serif;mso-fareast-font-family:"Times New Roman"; mso-fareast-language:DE">Generell keine Empfehlung</span> | ***<span style="font-family:"Arial",sans-serif;mso-fareast-font-family:"Times New Roman"; mso-fareast-language:DE">Generell keine Empfehlung</span> | ||
*** <span style="font-family:"Arial",sans-serif;mso-fareast-font-family:"Times New Roman"; mso-fareast-language:DE">Im Einzelfall</span> | ***<span style="font-family:"Arial",sans-serif;mso-fareast-font-family:"Times New Roman"; mso-fareast-language:DE">Im Einzelfall</span> | ||
**** <span style="color: black">bei CRSsNP ''(''</span>''<span style="color: #212121">Chronic rhinosinusitis without nasal polyps</span><span style="color: #212121">)</span>''<span style="color: #212121"> </span><span style="color: black">Clarithromycin bei Versagen der Standardtherapie evaluieren </span> | ****<span style="color: black">bei CRSsNP ''(''</span>''<span style="color: #212121">Chronic rhinosinusitis without nasal polyps</span><span style="color: #212121">)</span>''<span style="color: #212121"> </span><span style="color: black">Clarithromycin bei Versagen der Standardtherapie evaluieren </span> | ||
**** <span style="color: black">Bei CRScNP ''(''</span>''<span style="color: #212121">Chronic rhinosinusitis with nasal polyps</span><span style="color: #212121">)</span>''<span style="color: black"> im Falle einer Rezidiv-Polyposis Doxycyclin evaluieren </span> | ****<span style="color: black">Bei CRScNP ''(''</span>''<span style="color: #212121">Chronic rhinosinusitis with nasal polyps</span><span style="color: #212121">)</span>''<span style="color: black"> im Falle einer Rezidiv-Polyposis Doxycyclin evaluieren </span> | ||
* <span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Chirurgische Therapie</span> | *<span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Chirurgische Therapie</span> | ||
** <span style="font-family:"Arial",sans-serif">mangelnde Symptombesserung nach einem suffizienten medikamentösen Therapieversuch</span> | **<span style="font-family:"Arial",sans-serif">mangelnde Symptombesserung nach einem suffizienten medikamentösen Therapieversuch</span> | ||
** <span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">bei entzündlichen Komplikationen</span> | **<span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">bei entzündlichen Komplikationen</span> | ||
*** <span style="font-family:"Arial",sans-serif;mso-fareast-font-family:"Times New Roman"; mso-fareast-language:DE">Abszesse</span> | ***<span style="font-family:"Arial",sans-serif;mso-fareast-font-family:"Times New Roman"; mso-fareast-language:DE">Abszesse</span> | ||
*** <span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Orbitaödem</span> | ***<span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Orbitaödem</span> | ||
*** <span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Endokranielle Komplikationen</span> | ***<span style="font-family:"Arial",sans-serif; mso-fareast-font-family:"Times New Roman";mso-fareast-language:DE">Endokranielle Komplikationen</span> | ||
*** <span style="font-family:"Arial",sans-serif;mso-fareast-font-family:"Times New Roman"; mso-fareast-language:DE">Osteomyelitis im Bereich des Schädelknochens</span> | ***<span style="font-family:"Arial",sans-serif;mso-fareast-font-family:"Times New Roman"; mso-fareast-language:DE">Osteomyelitis im Bereich des Schädelknochens</span> | ||
<br /> | <br /> | ||
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Revision as of 20:12, 2 February 2021
Therapie
Akute Rhinosinusitis
Spontanheilungsraten von > 50% nach 1 Woche, 60-80% nach 2 Wochen, und über > 90% nach 4 Wochen
Wenn Patient 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
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| Klinische Situation | Präferenz | Substanz | Dosierung | Dauer | Anpassungen | Kommentar |
| Bakterielle Rhinu-sinusitis | Therapie der Wahl | Amoxicillin | 500 mg p.o. 3x/d | 7-10d | - | |
| 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
- 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
- Short-term Applikation
- Chirurgische Therapie
- mangelnde Symptombesserung nach einem suffizienten medikamentösen Therapieversuch
- bei entzündlichen Komplikationen
- Abszesse
- Orbitaödem
- Endokranielle Komplikationen
- Osteomyelitis im Bereich des Schädelknochens
- ↑ 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.
- ↑ Sinusitis and antibiotics. Lancet Infect Dis, 2012. 12(5): p. 355.
- ↑ 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.
- ↑ 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.
- ↑ Sedaghat, A.R., Chronic Rhinosinusitis. Am Fam Physician, 2017. 96(8): p. 500-506.