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Medical management of acute bacterial sinusitis. Recommendations of a clinical advisory committee on pediatric and adult sinusitis.

Acute sinusitis is commonly encountered in clinical practice and treated in the primary care setting. The clinician should recognize the subtle clinical presentation of acute bacterial sinusitis and initiate appropriate, aggressive treatment. Other upper respiratory tract disorders can confound the accurate diagnosis and appropriate treatment of sinusitis. Variable patterns of microbial resistance and antibiotic susceptibility and the dissociation between in vitro findings and clinical efficacy are a treatment challenge. This report is a comprehensive review of the pathophysiology and diagnosis of acute sinusitis, infectious agents, treatment methods, antibiotic resistance patterns, and costs associated with the management of sinusitis. Treatment algorithms are presented for adult and pediatric sinusitis.

Acute Disease↗

Delayed supply of influenza vaccine and adjunct ACIP influenza vaccine recommendations for the 2000-01 influenza season. Advisory Committee on Immunization Practices.

Annual vaccination against influenza is the primary means for minimizing serious adverse outcomes from influenza virus infections. These infections result in approximately 20,000 deaths and 110,000 hospitalizations per year in the United States (1). The amount of trivalent inactivated influenza vaccine produced for distribution in the United States has increased substantially; in 1999, four manufacturers produced a combined total of 80 to 85 million doses.

Humans↗

Controversies in the medical management of persistent and recurrent acute otitis media. Recommendations of a clinical advisory committee.

Streptococcus pneumoniae is the predominant bacterial pathogen associated with acute otitis media (AOM), causing an estimated 7 million cases annually in the United States. Bacterial resistance should be considered when selecting an antimicrobial agent for otitis media. Significant increases in drug-resistant S pneumoniae are documented worldwide, and less than 50% of S pneumoniae strains are fully susceptible to penicillin in some regions of the United States. Although amoxicillin is recommended for uncomplicated AOM, treatment guidelines should be flexible and adaptable, taking into consideration local and regional susceptibility patterns, the age of the patient, the frequency of prior infections, and the response to prior therapy. Resistant organisms are more prevalent in children younger than 2 years of age and in those who have recurrent or persistent AOM. Overdiagnosing AOM, selecting inappropriate empiric therapy, or both, leads to overuse and misuse of antibiotics and causes increased drug resistance. This article reviews persistent and recurrent AOM and discusses the pitfalls of diagnosis and the practical limitations of current treatment recommendations.

Acute Disease↗

The 12th Report of the Human Renal Transplant Registry. Prepared by the Advisory Committee to the Renal Transplant Registry.

This report, the 12th, from the Renal Transplant Registry summarizes current results of kidney transplantation in man. There has been a trend toward increasing use of cadaveric sources for kidney transplantation. Results are summarized in five-year life-table analyses of recipient survival and graft function. Also, a summary of the results of special studies is provided. These include preparation of the recipient for transplantation by nephrectomy in various disease states, comparison of simple flushing with machine perfusion in cadaveric kidney storage, results of transplantation in the pediatric recipient, and the development of malignant neoplasm in graft recipients. A large study relating typing to graft function presents information at some variance from previous reports published in the United States.

Adolescent↗

Guidelines for the microbiological quality of some ready-to-eat foods sampled at the point of sale. PHLS Advisory Committee for Food and Dairy Products.

These guidelines for the microbiological quality of ready-to-eat foods represent a revision and expansion of guidelines first published by the PHLS in September 1992 and revised in March 1996. The latest guidelines incorporate many of the constructive comments received from food examiners and other microbiologists within and outside the PHLS and from environmental health officers throughout the United Kingdom. This document reviews the changes and the reasons they were made and sets out the new guidelines. It also clarifies the role of food examiners in interpreting the microbiological results of formal samples.

Colony Count, Microbial↗