Brook Itzhak
Department of Pediatrics Georgetown University School of Medicine Washington D.C. U.S.A.
Laryngoscope Investig Otolaryngol. 2017 Mar 10;2(3):104-108. doi: 10.1002/lio2.67. eCollection 2017 Jun.
Presenting the role of antibiotics in pediatric chronic rhinosinusitis based on its pathophysiology and microbiology.
Review of the literature searching PubMed for microbiology and treatment of pediatric chronic rhinosinusitis.
Chronic rhinosinusitis (CRS) is an inflammatory condition of the paranasal sinuses that persists for 12 weeks or longer, despite medical management. The microbiology of rhinosinusitis evolves through several stages. The early phase (acute) is generally caused by a virus that may be followed by an aerobic bacterial infection in 2% to 10% of patients. Aerobic () and anaerobic (Prevotella and Fusobacteria) members of the oral flora emerge as predominant sinus cavity isolates. Antimicrobials are one component of comprehensive medical and surgical management for this disorder. Because most of these infections are polymicrobial and many include beta-lactamase producing aerobic and anaerobic organisms, amoxicillin-clavulanate is the first-line regimen for most patients. Clindamycin is adequate for penicillin-allergic children and is also generally appropriate for methicillin resistant treatment is administered for at least three weeks and may be extended for up to 10 weeks in refractory cases. A culture preferably from the sinus cavity should be obtained from individuals who have not shown improvement or deteriorated despite therapy.
Antimicrobial therapy of pediatric chronic rhinosinusitis should be adequate against the potential aerobic and anaerobic pathogens.
根据小儿慢性鼻-鼻窦炎的病理生理学和微生物学阐述抗生素在其中的作用。
检索PubMed中关于小儿慢性鼻-鼻窦炎微生物学和治疗的文献综述。
慢性鼻-鼻窦炎（CRS）是鼻窦的一种炎症性疾病，尽管经过药物治疗仍持续12周或更长时间。鼻-鼻窦炎的微生物学演变经历几个阶段。早期（急性期）通常由病毒引起，2%至10%的患者随后可能发生需氧菌感染。口腔菌群中的需氧菌（ ）和厌氧菌（普雷沃菌属和梭杆菌属）成为鼻窦腔的主要分离菌。抗菌药物是这种疾病综合药物和手术治疗的一个组成部分。由于这些感染大多是多微生物感染，许多包括产β-内酰胺酶的需氧菌和厌氧菌，阿莫西林-克拉维酸是大多数患者的一线治疗方案。克林霉素适用于对青霉素过敏的儿童，通常也适用于耐甲氧西林 治疗至少持续三周，难治性病例可能延长至10周。对于尽管接受治疗但病情未改善或恶化的患者，最好从鼻窦腔获取培养物。
小儿慢性鼻-鼻窦炎的抗菌治疗应足以对抗潜在的需氧菌和厌氧菌病原体。
7级。
