儿童鼻窦炎的治疗:意大利社会共识(SIPPS-SIP-SITIP-FIMP-SIAIP-SIMRI-SIM-FIMMG)。

IF 3.2 3区 医学 Q1 PEDIATRICS
Elisabetta Venturini, Margherita Del Bene, Lara Fusani, Eleonora Fusco, Alessia Morlando, Elena Chiappini, Maria Carmen Verga, Giuseppe Di Mauro, Silvia Garazzino, Guido Castelli Gattinara, Susanna Esposito, Eugenia Bruzzese, Nicola Principi, Gian Luigi Marseglia, Fabio Midulla, Mattia Doria, Daniele Donà, Stefania Stefani, Annalisa Capuano, Paolo Biasci, Antonio D'Avino, Annamaria Staiano, Alfredo Guarino, Andrea Lo Vecchio, Luisa Galli
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引用次数: 0

摘要

鼻窦炎是一种副鼻窦粘膜的炎症。细菌性鼻窦炎通常是上呼吸道病毒感染的并发症,也是就诊的常见原因。急性细菌性鼻窦炎的临床表现各不相同。它最常见的表现是上呼吸道感染(鼻塞、鼻后滴涕、咳嗽),持续10天以上而无临床改善。不幸的是,目前还没有更新的儿科年龄指南。这一共识的目的是提供指导方针的治疗管理以前健康的儿童鼻窦炎患者。进行了系统审查,以确定最新和相关的证据。对Embase、Scopus、PubMed和Cochrane数据库进行系统筛选,将“儿童”、“鼻窦炎”、“抗生素”和“鼻窦炎”这几个词结合起来,时间限制从2012年到2024年4月,但没有语言限制。证据的确定性采用分级推荐评估、发展和评价(GRADE)方法进行评估。最后的建议是通过专家小组的德尔菲共识获得的。对于诊断为无并发症急性细菌性鼻窦炎的儿童,根据严格的临床标准,应采用阿莫西林或阿莫西林-克拉维酸进行全身经经验抗生素治疗,高剂量(90mg /kg/天,根据阿莫西林计算,最好是每天3次),至少持续10天。对于患有慢性鼻窦炎的儿童,不建议进行全身抗生素治疗,由于缺乏支持治疗的科学证据,因此不可能对抗生素药物提出任何具体建议。总之,鼻窦炎的诊断主要是临床,尽管急性鼻窦炎通常有一个良好的病程,但一些病例可能出现眼眶和颅内并发症。在处理上呼吸道感染(包括急性鼻窦炎)时滥用抗生素以及抗生素耐药性带来的挑战是儿科护理中当前面临的一个问题。由于现有证据的稀缺性、异质性和低质量,支持或反对在鼻窦炎儿童中使用全身抗生素治疗的前瞻性研究需要更大、更均匀的队列。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Treatment of sinusitis in children: an Italian intersociety consensus (SIPPS-SIP-SITIP-FIMP-SIAIP-SIMRI-SIM-FIMMG).

Sinusitis is an inflammation of the mucous membrane of the paranasal sinuses. Bacterial sinusitis usually occurs as a complication of viral infections of the upper respiratory tract and is a frequent cause of medical consultation. The clinical presentation of acute bacterial sinusitis can vary. It most commonly manifests as an upper respiratory tract infection (nasal congestion, postnasal drip, cough) that persists for more than 10 days without clinical improvement. Unfortunately, updated guidelines in paediatric age are not currently available. The purpose of this consensus is to provide guidelines for the therapeutic management of previous healthy paediatric patients with sinusitis. A systematic review was conducted to identify the most recent and relevant evidence. Embase, Scopus, PubMed, and Cochrane databases were systematically screened, combining the terms "children" and "sinusitis" and "antibiotics" and "rhinosinusitis" with a date restriction from 2012 to April 2024, but without language limitations. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methods. The final recommendations were obtained through a Delphi consensus of an expert panel. In children with a diagnosis of uncomplicated acute bacterial sinusitis, made according to strict clinical criteria, systemic empiric antibiotic therapy with amoxicillin or amoxicillin-clavulanic acid is indicated at a high dose (90 mg/kg/day, calculated based on amoxicillin, preferably in 3 daily doses) and for at least 10 days. In children with chronic sinusitis, systemic antibiotic treatment is not recommended, and it is not possible to make any specific recommendation regarding antibiotic agents due to the scarcity of scientific evidence supporting treatment. In conclusion, the diagnosis of sinusitis is primarily clinical, and despite acute sinusitis generally having a favourable course, some cases can present orbital and intracranial complications. The misuse of antibiotics in managing upper respiratory tract infections, including acute sinusitis, and the challenges posed by antibiotic resistance are a current issue in paediatric care. Due to the scarcity, heterogeneity, and poor quality of available evidence either supporting or opposing the use of systemic antibiotic therapy in children with sinusitis prospective studies on larger and more homogeneous cohort are needed.

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来源期刊
CiteScore
6.10
自引率
13.90%
发文量
192
审稿时长
6-12 weeks
期刊介绍: Italian Journal of Pediatrics is an open access peer-reviewed journal that includes all aspects of pediatric medicine. The journal also covers health service and public health research that addresses primary care issues. The journal provides a high-quality forum for pediatricians and other healthcare professionals to report and discuss up-to-the-minute research and expert reviews in the field of pediatric medicine. The journal will continue to develop the range of articles published to enable this invaluable resource to stay at the forefront of the field. Italian Journal of Pediatrics, which commenced in 1975 as Rivista Italiana di Pediatria, provides a high-quality forum for pediatricians and other healthcare professionals to report and discuss up-to-the-minute research and expert reviews in the field of pediatric medicine. The journal will continue to develop the range of articles published to enable this invaluable resource to stay at the forefront of the field.
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