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PubMed1998

An interactive workshop: An effective means of integrating the Canadian Cardiovascular Society clinical practice guidelines on congestive heart failure into Canadian family physicians' practice.

OBJECTIVE: To use an interactive workship as a means of integrating clinical practice guidelines on congestive heart failure into Canadian family physicians' practice. SETTING: Interested practitioners from the Association des Médecins Omnipraticiens de Québec, the Centre de Santé Publique de Québec and the continuing medical education (CME) department, Merck Frosst Canada, Montreal, formed the initial task force. Train-the-trainer sessions took place in many provinces in a variety of CME settings. DESIGN: The interactive, problem-based workshop was facilitated by local interested general practitioners, while local experts served as consultants to reinforce key messages from clinical practice guidelines and to guide participants through the learning process. MAIN RESULTS: By December 31, 1996, 187 family practitioners and 81 specialists had been trained in train-the-trainer sessions across the country. A total of 1698 general practitioners had participated in over 52 workshops during the same time. Pre- and postworkshop testing indicate that the workshops improved knowledge, and that the knowledge gained during the workshop was retained at three- and six-months' follow-up. Separate chart evaluations conducted before and after the workshop showed that participants provided more complete chart information related to congestive heart failure and that they significantly increased their use of angiotensin-converting enzyme inhibitor therapy after the workshop. Participant evaluation of the workshop also indicates a high index of satisfaction with the presentation and the content of the workshop as being relevant to clinical practice. CONCLUSION: An interactive, problem-based, small group workshop developed by a core group of interested practitioners and guided by local trained facilitators and experts is an effective teaching tool through which clinical practice guidelines can be successfully transferred into clinical practice in a timely and meaningful way.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1996

Central dimensions of clinical practice evaluation: efficiency, appropriateness and effectiveness--I.

Successful audit of clinical practice focuses upon the systematic investigation of key aspects of the everyday work of busy clinicians. We contend that the nature and quality of local clinical practice can be characterized by critical examinations of the effectiveness and appropriateness of practice and the efficiency with which effective, appropriate clinical care is delivered to patients. When such a baseline has been established, it becomes possible to compare and contrast characterized local practice with so-called 'evidence-based' practice and agree changes aimed at narrowing the discrepancy between the two. The nature of such changes can be described and their implementation into practice studied, with subsequent quantitative measurement and qualitative description of the resulting benefits to patients. A proper understanding of the concepts of efficiency, appropriateness and effectiveness in clinical care is clearly fundamental to the successful design and applications of methodologies aimed at securing measurable improvements in the quality of patient care. In this first of two articles we examine the concepts of efficiency and appropriateness in clinical practice, with particular emphasis on cost-effectiveness and utilization review. The clinical effectiveness of health care intervention is treated in detail within the second paper, to be published within Volume 2 Number 2 of the Journal of Evaluation in Clinical Practice (Miles et al. 1996f).

Clinical Medicine↗
PubMed1999

Why don't physicians follow clinical practice guidelines? A framework for improvement.

CONTEXT: Despite wide promulgation, clinical practice guidelines have had limited effect on changing physician behavior. Little is known about the process and factors involved in changing physician practices in response to guidelines. OBJECTIVE: To review barriers to physician adherence to clinical practice guidelines. DATA SOURCES: We searched the MEDLINE, Educational Resources Information Center (ERIC), and HealthSTAR databases (January 1966 to January 1998); bibliographies; textbooks on health behavior or public health; and references supplied by experts to find English-language article titles that describe barriers to guideline adherence. STUDY SELECTION: Of 5658 articles initially identified, we selected 76 published studies describing at least 1 barrier to adherence to clinical practice guidelines, practice parameters, clinical policies, or national consensus statements. One investigator screened titles to identify candidate articles, then 2 investigators independently reviewed the texts to exclude articles that did not match the criteria. Differences were resolved by consensus with a third investigator. DATA EXTRACTION: Two investigators organized barriers to adherence into a framework according to their effect on physician knowledge, attitudes, or behavior. This organization was validated by 3 additional investigators. DATA SYNTHESIS: The 76 articles included 120 different surveys investigating 293 potential barriers to physician guideline adherence, including awareness (n = 46), familiarity(n = 31), agreement (n = 33), self-efficacy (n = 19), outcome expectancy (n = 8), ability to overcome the inertia of previous practice (n = 14), and absence of external barriers to perform recommendations (n = 34). The majority of surveys (70 [58%] of 120) examined only 1 type of barrier. CONCLUSIONS: Studies on improving physician guideline adherence may not be generalizable, since barriers in one setting may not be present in another. Our review offers a differential diagnosis for why physicians do not follow practice guidelines, as well as a rational approach toward improving guideline adherence and a framework for future research.

Attitude of Health Personnel↗
PubMed2003

Physician attitudes toward strategies to promote the adoption of medical evidence into clinical practice.

BACKGROUND: [corrected] Promoting the adoption of medical evidence into clinical practice has been advocated as one approach to improving healthcare quality and reducing medical errors. Data describing the effectiveness of different strategies to achieve this goal in real-world settings are limited. OBJECTIVE: To determine the effectiveness of selected interventions on the adoption of medical evidence into clinical practice. STUDY DESIGN: A cross-sectional survey of a random sample of physicians selected from the American Medical Association's Physician Master File. PATIENTS AND METHODS: We examined the perceived effectiveness of 7 strategies (represented by 27 individual interventions) and 5 general approaches for promoting the adoption of medical evidence into clinical practice in 1100 practicing physicians. Respondent exposure to interventions was also determined. Regression analyses were performed to identify factors that affected effectiveness ratings. Analysis of variance was used to test the hypothesis of equal mean scores across different comparison groups. RESULTS: Of 1,100 surveys mailed, 63 (5.7%) were excluded and 431 were completed (response rate = 41.6%). Mean +/- SD effectiveness scores for the 27 individual interventions on a 5-point Likert scale ranged from 2.0 +/- 0.9 (literature received from insurance companies and managed care organizations) to 4.2 +/- 0.8 (one-on-one communication with respected colleagues). Ranges for the 7 strategies were 2.6 +/- 1.0 (patient-mediated interventions) to 3.6 +/- 0.9 (educational meetings) and for the 5 general approaches were 1.98 +/- 0.9 (administrative interventions) to 3.3 +/- 0.8 (provider education). The hypothesis of equal mean effectiveness scores was rejected for all comparisons (P < .001). Frequency of exposure was the only variable to predict effectiveness (P < .001 for all regression models). CONCLUSION: From the perspective of practicing physicians, the frequency of exposure to strategies for promoting the adoption of medical evidence into clinical practice strongly affects their perceived effectiveness.

Attitude of Health Personnel↗
PubMed2005

Effectiveness of clinical practice guideline implementation on lower third molar management in improving clinical decision-making: a randomized controlled trial.

The objective of this study was twofold, namely to evaluate the effectiveness of a dental clinical practice guideline on the management of asymptomatic impacted lower third molars (i) on referral rates and (ii) on dentists' change in knowledge. A two-arm cluster randomized controlled trial, with pre- and post-test assessments, was conducted. A guideline was implemented by multifaceted interventions (i.e. feedback, reminders, and an interactive meeting). The effect was evaluated after 1 yr by repeating the baseline questionnaire and by monitoring the number of patients who were referred for removal of their asymptomatic impacted mandibular third molars. Instruments were questionnaires for detecting changes in knowledge, patient records, and panoramic radiographs. The knowledge of dentists regarding asymptomatic mandibular third molar management was found to increase significantly in the intervention group as compared to the control group. There was no statistically significant difference between the groups in guideline-consistent patient referral rates at the post-test assessment. It was concluded that the methodology employed for dissemination and implementation of a clinical practice guideline on asymptomatic mandibular third molar management improves dentists' knowledge on this topic and is effective in improving decision-making in simulated cases; however, no clinical effect was demonstrated.

Communication↗
PubMed1996

Clinical practice arrangements of physician faculty in family practice residency programs.

BACKGROUND AND OBJECTIVES: This descriptive study sought information on the types of clinical practice arrangements and the nature of clinical responsibilities of full-time physician faculty in family practice residency programs. METHODS: A four-page, 37-item, self-administered questionnaire was sent to a 20% proportionate, systematic randomly sampled group of family practice faculty. Simple descriptive statistics were used for demographic and clinical practice data. Clinical practice characteristics were compared by the three most frequent clinical practice arrangements (private practice, on-site practice, and off-site practice) to determine differences. RESULTS: The majority of respondents were white, board-certified males. Most faculty saw patients two (26.9%) or three (27.7%) half days per week and between 6-10 (47.5%) and 11-15 (41.1%) patients per session. The most frequent clinical practice arrangements were having faculty see patients in their own private practice (5.3%), as part of the faculty practice in the residency program's health center (72.9%), and as part of the faculty practice remote from the residency program's health center (11.7%). There were no differences among the three arrangements with respect to clinical sessions per week, taking call at night to back up the resident on call, seeing patients outside of regularly scheduled office hours, making house calls, following patients in the nursing home, or offering pregnancy care. CONCLUSIONS: Further research is needed to determine the advantages and disadvantages of different clinical practice arrangements for the clinical skills and role-modeling ability of family physician faculty.

Adult↗
PubMed1990

Good clinical practices in phase I studies.

In France, official guidelines for good clinical practices in clinical trials were issued in 1987. In December 1988, a law was passed that fixed the requirements for carrying out experiments in healthy subjects. It will be completed by official guidelines for the structures in which experiments on healthy subjects (and patients as well, when the investigation would not benefit the health of the patients) may be conducted. Hence a battery of recent legal instructions precisely state what good clinical practices are in the setting of phase I studies. Of particular importance are: subject recruitment and selection methods and procedures; specific competence of the investigator, in particular to interpret the pre-trial data; necessary and sufficient facilities to guarantee the subjects' safety; careful quality control to check all laboratory procedures; necessity of written standard operating procedures.

Drug Evaluation↗
PubMed2001

Is more than one quinolone needed in clinical practice?

OBJECTIVE: To review clinical information on fluoroquinolone antimicrobials to distinguish between these agents and help define their place in clinical practice. DATA SOURCES: Primary and review articles on fluoroquinolones available commercially in the US as of August 2000 were identified through MEDLINE (from 1993-August 2000) and secondary sources. STUDY SELECTION AND DATA EXTRACTION: All pertinent, published, clinical trials for levofloxacin, moxifloxacin, and gatifloxacin were included. Minimal data were included for quinolones with restricted or limited uses, including trovafloxacin, sparfloxacin, enoxacin, and lomefloxacin. Due to the quantity of data on ciprofloxacin, only more recent or pivotal trials or articles summarizing data on specific infections were included. Relevant information was included if it was believed to assist in differentiating between the fluoroquinolones for infections for which these agents would most commonly be considered. DATA SYNTHESIS: Fluoroquinolones are a potent class of intravenous and oral broad-spectrum antimicrobial agents used for treating a wide range of community-acquired and nosocomial infections. More than 10 quinolones have been approved for use; although some of these have been withdrawn from the market, numerous others are under investigation. It has become increasingly important to be able to differentiate between these agents. CONCLUSIONS: Differences in safety, antimicrobial spectrum of activity, and resistance development support the selective use of various fluoroquinolones in differing clinical situations.

Anti-Infective Agents↗
PubMedDate not supplied

A prospective safety study of allergen immunotherapy in daily clinical practice.

BACKGROUND: Despite its clinical effectiveness, allergen immunotherapy (AIT) remains controversial because serious systemic reactions can occur during its administration. Most of the studies on the safety of AIT are retrospective and use different methods, which frequently depart from daily clinical practice. OBJECTIVE: The aim of this study was to determine risk factors for adverse reactions, especially systemic adverse reactions, produced during routine AIT administration. METHODS: We registered 5,768 consecutive doses of standardized extracts administered to 273 patients in conventional schedules, following the recommendations on safety and data collection of the European Academy of Allergology and Clinical Immunology. Of the 273 patients, 236 were asthmatics, 28 had rhinitis and 9 received immunotherapy due to Hymenoptera anaphylaxis. RESULTS: We examined 143 local reactions (2.48 % of the doses) and 145 systemic reactions (78 immediate and 67 delayed). Risk factors for developing an immediate systemic reaction were asthma severity, sensitization to molds, the most concentrated vials and a fall in peak expiratory flow of more than 15 % or an immediate systemic reaction in the previous dose. Late systemic reactions were significantly more frequent with less concentrated vials and in patients with late local reactions in the previous dose. No serious reactions were registered. CONCLUSIONS: We believe that AIT is reliable when used with strict safety protocols and administered by specialized staff. Risk factors for adverse reactions to this type of treatment can be identified and reduced by systematic data collection.

Adolescent↗
PubMed2000

[Mapping the scientific evidence for bedside care to unstable angina. A preliminary step to develop clinical guidelines. The name of the study group CAMBIE Change in the Medical services based on the clinical practice guidelines].

BACKGROUND: The uncertainty in clinical practice arise from the need of physicians to make decisions on a limited ground of knowledges. Guidelines are supposed to facilitate clinical decisions in such circumstances. Sharing knowledges on natural history of diseases and clinical expertise allow to define and array of steps structured on a formal flow-chart. The node of algorithms identifies decisions to analyze. This paper presents a taxonomy of specific questions related to each decision nodes for management of unstable angina and assesses the level of evidence available for each question. MATERIAL AND METHOD: A flow chart diagram display the conceptualized key nodes for clinical management of unstable angina. A set of specific question related to clinical exclusive circumstances, diagnostic approach, utility of diagnostic procedures, definition of prognosis and outcomes was raised for each decision node. From a systematic literature review the best available evidence was gathered. Each recommendation was linked to a level (A-C) of evidence, and to a body of consensus expert panel decisions. RESULTS: 34 decision nodes were identified, related with at least 1 question for appraisal of the best evidence. The solution to these questions yielded 40 recommendations scored by the strength of the evidence available. Five recommendations of diagnostic, 20 at prognostic and 15 at therapeutic step. The strength of evidence was A for 73% of recommendations at therapeutic step versus 40% at the two other steps. CONCLUSIONS: A clinical complex problem can be displayed in a continuous process, to allow identification and appraisal of decisions at different clinical nodes. The work-up to achieve a conceptualization of a clinical problem is the preliminary step to develop clinical practice guidelines. Identification of decision nodes allows to manage uncertainty in a explicit way and make policy statement more acceptable by managers and physicians.

Algorithms↗
PubMed2001

Antidepressant use in clinical practice: efficacy v. effectiveness.

BACKGROUND: Although the efficacy of antidepressants has been demonstrated in randomised, controlled clinical trials, it is how an antidepressant is used in clinical practice that determines its clinical effectiveness, or real-world efficacy. AIMS: To explore the frequency with which antidepressants are used at adequate dose and duration to obtain remission of symptoms and prevent relapse in clinical practice and discuss potential implications for clinical outcomes. METHOD: Studies of antidepressant prescribing were reviewed and comparisons made between antidepressant classes and individual compounds within those classes. RESULTS: Naturalistic studies show that patients who begin therapy on tricyclic antidepressants often receive sub-therapeutic doses for inadequate duration; conversely, patients who begin therapy on selective serotonin reuptake inhibitors more often receive an adequate dose of therapy for a longer duration. CONCLUSIONS; How antidepressants are used in clinical practice can determine the clinical outcomes that are achieved. Antidepressants that are more forgiving of sub-optimal prescribing and use patterns by providers and patients, respectively, may help to improve real-world efficacy.

Antidepressive Agents↗
PubMed2001

National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure.

The National Kidney Foundation Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Nutrition in Chronic Renal Failure was recently published in the American Journal of Kidney Diseases. This publication provides 27 clinical practice guidelines for adults and 10 clinical practice guidelines for children. The adult guidelines focus primarily on patients undergoing maintenance dialysis therapy, although there are several clinical practice guidelines on nutritional issues for patients with advanced chronic renal failure (CRF) not undergoing dialysis therapy. The pediatric guidelines focus entirely on children undergoing maintenance dialysis treatment. The present article discusses a number of the more prominent clinical practice guidelines for the adults. Among these is the recommendation that the protein-energy nutritional status in these patients should be assessed by a panel of measures rather than by any single measure. Also, non-dialyzed patients with advanced CRF (ie, glomerular filtration rate <25 mL/min) and those undergoing maintenance hemodialysis or chronic peritoneal dialysis should be prescribed a dietary energy intake of 35 kcal/kg/day for patients who are <60 years of age and 30 kcal/kg for patients >/=60 years of age. Maintenance hemodialysis patients should be prescribed 1.2 g protein/kg/d; chronic peritoneal dialysis patients should be prescribed 1.2 to 1.3 g protein/kg/d. For non-dialyzed patients with CRF (glomerular filtration rate <25 mL/min), 0.60 g protein/kg/d should be prescribed. For patients who will not accept such a diet or are unable to maintain an adequate energy intake on that diet, a protein intake of up to 0.75 g protein/kg/d may be prescribed. At least 50% of the protein intake for all of these patients should be of high biologic value. A guideline concerning indications for inaugurating maintenance dialysis treatment or renal transplantation on the basis of deteriorating nutritional status is also given.

Humans↗
PubMed2005

Using clinical practice guidelines to improve patient care.

Clinical practice guidelines incorporate the best available evidence for the management of a disease or an aspect of disease treatment or prevention into a single document for health care providers. The quality of practice guidelines has improved by adopting standard approaches to the development of guidelines and reviewing their quality for use in patient care. Implementing guidelines into clinical practice can improve quality and efficiency of care and will likely benefit from a multidisciplinary, multifaceted approach.

Decision Making↗
PubMed2006

Clinical practice guideline use by oncology advanced practice nurses.

Understanding how clinical practice guidelines (CPGs) are utilized and the effects of their implementation on outcomes is an important goal. The purpose of this investigation was to determine if oncology advanced practice nurse (APN) interventions provided to men with prostate cancer were consistent with Agency for Healthcare Policy and Research CPGs regarding pain [U.S. Department of Health and Human Services. (1993). Acute pain management in adults: Operative procedures. Quick reference guide for clinicians number 1a (AHCPR Publication No. 92-0019). Retrieved, February 23, 2002, from National Library of Medicine HSTAT Collection Online ], depressive symptoms [U.S. Department of Health and Human Services. (1993). Depression in primary care: Detection, diagnosis, and treatment. Quick reference guideline number 5 (AHCPR Publication No. 93-0552). Retrieved, February 23, 2002, from National Library of Medicine HSTAT Collection Online ], and urinary incontinence [U.S. Department of Health and Human Services. (1996). Managing acute and chronic urinary incontinence. Quick reference guide for clinicians number 2 (1996 update) (AHCPR Publication No. 96-0686). Retrieved, February 23, 2002, from National Library of Medicine HSTAT Collection Online ] and to evaluate if levels of consistency affected pain, depressive symptom, and incontinence outcomes. Mean levels of consistency between interventions and pain, incontinence guidelines, and depression were 91%, 80%, and 69%, respectively. Consistency did not predict outcomes in this sample. High levels of consistency suggest that oncology APNs are aware of practices outlined in CPGs.

Aged↗
PubMed2003

[Chest pain in clinical practice: impact of routine troponin determination on clinical manifestations and care].

UNLABELLED: INTRODUCTION AND OBJECTIVES. To study the significance of chest pain in the clinical practice of a Spanish hospital and to evaluate the impact of routine troponin determination. METHODS: In our institution, routine serial measurements of troponins I and T were made in the evaluation of chest pain in 2000. We compared the results obtained in 1999 for all patients who visited the emergency room for chest pain and the patients who were hospitalized. We recorded the diagnosis at discharge, duration of the hospital stay, and associated costs. RESULTS: In 2000, 1,820 patients with chest pain visited the emergency department, which was equivalent to 1.9% of visits and 7.5 cases per 1,000 people and year: 43% of these patients were hospitalized for suspected acute coronary syndrome as compared to 49% in 1999 (-12%; p > 0.001). Among the patients admitted, 28% were discharged with a diagnosis of non-ischemic chest pain. Troponin determinations were associated with a lower probability of admission due to unstable angina (11.5 vs 16.0%; -28%; p < 0.001) and non-ischemic chest pain (12.1 vs 14.5%; -16%; p < 0.05), and an increase in diagnoses of non-Q wave acute myocardial infarction (3.4% vs 1.8%; +89%; p < 0.01). Non-ST elevation acute coronary syndrome ACS required 3,751 days of hospitalization and 1,003,420 euros of cost, and troponin determinations were associated with a reduction in hospital stays of 832 days (-18.2%) and 185,100 euros (-15.6%). CONCLUSION: Chest pain had a high incidence, 7.5, and generates high costs in hospital admissions. The routine use of serial troponin determinations was associated with a reduction in hospital admissions due to unstable angina and non-ischemic chest pain, and costs.

Angina, Unstable↗
PubMed1999

The cost of implementing the Dialysis Outcomes Quality Initiative Clinical Practice Guidelines.

For a clinical practice guideline to be accepted by the end-user, the system of reimbursement for the targeted service must be favorable. The National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) Guideline recommendations were developed without primary concern for the costs of their execution. Arguably, an unfavorable financial environment and excessive mercantile behavior by providers and payers would offer a considerable hindrance to their implementation. Toward addressing these concerns, three leaders in the development of the DOQI Guidelines for the Treatment of Anemia of Chronic Renal Failure, Hemodialysis Adequacy, and Vascular Access, have evaluated the hypothesis that implementing the recommendations of the DOQI Guidelines will increase the treatment costs for dialysis providers but will effect savings in the entire end-stage renal disease (ESRD) program. Their analyses suggest that under the current reimbursement system, this assumption may be true. However, restructured global reimbursement in the ESRD program will permit financial incentives for dialysis providers and the payer to coincide.

Anemia↗
PubMed2003

The determination of the relevance of basic sciences learning objectives to clinical practice using a questionnaire survey.

OBJECTIVES: Facilitating sufficient understanding of the basic sciences to underpin clinical practice is important in producing the good doctor. However, the inclusion of irrelevant material in the curriculum not only wastes valuable learning time, but may also hinder learning. The aim of this study was to determine how relevant staff and students thought respiratory basic science learning objectives were to medical practice. DESIGN: The study involved a survey using an anonymous questionnaire to determine whether the respiratory learning objectives stated in Year 1 were perceived as relevant to clinical practice. Each learning objective was rated as being 'relevant', 'not relevant' or of 'uncertain relevance'. SETTING: Dundee Medical School, UK. SUBJECTS: Junior and senior students and staff. RESULTS: Year 1 students considered the majority of the learning objectives to be relevant to clinical practice. Staff and senior students identified some respiratory learning objectives as not relevant to clinical practice, most of which were related to biochemistry. CONCLUSIONS: The identification of learning objectives with questionable relevance to clinical practice requires careful consideration to determine whether these should be removed from the course. Attention needs to be given to both the presentation and process by which material is delivered to students. Strategies to emphasise the clinical relevance of the basic sciences to students are discussed. Further research needs to be conducted to evaluate what knowledge is essential for producing good doctors.

Clinical Competence↗
PubMed2001

Clinical practice guideline: management of sinusitis.

This clinical practice guideline formulates recommendations for health care providers regarding the diagnosis, evaluation, and treatment of children, ages 1 to 21 years, with uncomplicated acute, subacute, and recurrent acute bacterial sinusitis. It was developed through a comprehensive search and analysis of the medical literature. Expert consensus opinion was used to enhance or formulate recommendations where data were insufficient. A subcommittee, composed of pediatricians with expertise in infectious disease, allergy, epidemiology, family practice, and pediatric practice, supplemented with an otolaryngologist and radiologist, were selected to formulate the practice parameter. Several other groups (including members of the American College of Emergency Physicians, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Asthma, Allergy and Immunology, as well as numerous national committees and sections of the American Academy of Pediatrics) have reviewed and revised the guideline. Three specific issues were considered: 1) evidence for the efficacy of various antibiotics in children; 2) evidence for the efficacy of various ancillary, nonantibiotic regimens; and 3) the diagnostic accuracy and concordance of clinical symptoms, radiography (and other imaging methods), and sinus aspiration. It is recommended that the diagnosis of acute bacterial sinusitis be based on clinical criteria in children </=6 years of age who present with upper respiratory symptoms that are either persistent or severe. Although controversial, imaging studies may be necessary to confirm a diagnosis of acute bacterial sinusitis in children >6 years of age. Computed tomography scans of the paranasal sinuses should be reserved for children who present with complications of acute bacterial sinusitis or who have very persistent or recurrent infections and are not responsive to medical management. There were only 5 controlled randomized trials and 8 case series on antimicrobial therapy for acute bacterial sinusitis in children. However, these data, plus data derived from the study of adults with acute bacterial sinusitis, support the recommendation that acute bacterial sinusitis be treated with antimicrobial therapy to achieve a more rapid clinical cure. Children with complications or suspected complications of acute bacterial sinusitis should be treated promptly and aggressively with antibiotics and, when appropriate, drainage. Based on controversial and limited data, no recommendations are made about the use of prophylactic antimicrobials, ancillary therapies, or complementary/alternative medicine for prevention and treatment of acute bacterial sinusitis. This clinical practice guideline is not intended as a sole source of guidance in the diagnosis and management of acute bacterial sinusitis in children. It is designed to assist pediatricians by providing an analytic framework for evaluation and treatment. It is not intended to replace clinical judgment or establish a protocol for all patients with this condition.

Acute Disease↗