الفهرس 
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Abstract
Guidelines may assist physicians and patients in decisions about effective and safe care. To date little is known about the awareness of and adherence to evidence-based guidelines of bacterial rhinosinsuitis.
During the last decade the number of published guidelines has rapidly increased. Awareness of and adherence to evidence based clinical guidelines is considered vital for improving effectiveness, quality and safety of patient care. Clinical guidelines are considered valid if they are developed in a rigorous way, independently of vested interests of their developers and if they support decision making in practice and affect actual care (Aarts et al, 2011).Because of the large number of clinical practice guidelines available, guideline users, including practitioners, find it challenging to determine which guidelines are of high quality (Swtzerland, 2012). Acute rhinosinusitis in children is defined clinically as sudden onset of two or more of the symptoms:
- Nasal blockage/obstruction/congestion.
- Or discolored nasal discharge.
- Or cough (daytime and night-time).
For < 12 weeks; with symptom free intervals if the problem is recurrent (Fokkens et al., 2012).
There are some differences between some guidelines in diagnosis of acute bacterial rhinosinsuitis as American and European diagnose by persistent illness, worsening course and severe onset of URT manifestations (Ellen et al., 2010). While the Britich diagnose by two of the following, one to be: nasal congestion or obstruction, discharge, facial pain, olfactory disturbance AND either Endoscopic signs OR CT signs Anand et al., 2004). Also Canadian one diagnoses ABRS as the patient
must have nasal obstruction or purulence or discharge and at least one
other PODS symptom (Desrosiers et al., 2011). Most guidelines
recommend observation as 1st option of treatment in mild uncomplicated
cases (Hickner et al., 2001) (Eric et al., 2011) (Fokkens et al., 2012)
(Ellen et al., 2013).
While IDSA and Canadian ones do not offer observation as option
of treatment (Desrosiers et al., 2011) (Anthony et al., 2012).
Most guidelines recommend amoxicillin with or without
clavulanate as first-line treatment when a decision has been made to
initiate antibiotic treatment of acute bacterial sinusitis (Hickner et al.,
2001) (Fokkens et al., 2012) (Ellen et al., 2013). Also UMHS and
Canadian ones recommend Trimethoprim –sulfamethoxazole as another
option beside amoxicillin (Eric et al., 2011) (Desrosiers et al.,
2011).While British one recommend macrolides as 1st line antibiotics
(Ragab et al., 2004).
Most guidelines recommend amoxicillin high dose 875-1000mg
q8hr or amoxicillin- clvulanate- potassium, usual dose 875/125 q 12hr or
amoxicillin- clvulanate potassium, high dose 2000/125 q 12hr as second
line antibiotics (Hickner et al., 2001) (Fokkens et al., 2012) (Ellen et
al., 2013).While Canadian and UMHS recommend fluoroquinolones as
2nd line antibiotics (Eric et al., 2011) (Desrosiers et al., 2011).
Most guidelines weakly recommend use of adjuvant therapy
especially intranasal steroids in treatment of ABRS in children thinking
that the rationale for the use of intranasal corticosteroids in acute bacterial
sinusitis is that an anti-inflammatory agent thereby hastening recovery
(Yilmaz et al., 2000) Hickner et al., 2001) (Eric et al., 2011) (Fokkens
et al., 2012) (Anthony et al., 2012) (Ellen et al., 2013).While the Canadian one doesn’t recommend steroids and decongestants (Desrosiers
et al., 2011).
The aim of the study is to assess the adherence of family physicians
to different published guidelines dealing with acute bacterial
rhinosinusitis (ABRS) in children. The study was descriptive study. The
study sample was all family physicians registered and recorded in family
medicine department in faculty of medicine, Menofia University 2014-
2015.
They were from different government and different faculties. They
worked at different health care levels (primary, hospitals, centres and
private clinics).
Total number of physicians registered in family medicine
department in 2014-2015 was respectively 79 family physicians.
Questionnaire distributed to family physicians to assess the adherence to
acute bacterial rhinosinusitis guidelines. Sixty seven physicians were
responded and complete the questionnaires, in Respond rate (85.4%).
The study revealed that (70%) of studied family physicians were
not adherent to guidelines in dealing with ABRS while (30%) of them
were adherent to guidelines and the main cause of non-adherence among
studied physicians was due to lack of applicability, the delay in renewing
guidelines, ambiguous recommendations, focusing on patients with single
disease, lack of collaboration with other health care professionals and
environmental barriers. There is statistically no significant difference
between adherent and non-adherent family physicians regarding general
characteristics.