上呼吸道感染專區
不是黃鼻涕就要吃抗生素喔?細菌性鼻竇炎的診斷標準
黃鼻涕就是鼻竇炎,就要開始吃抗生素,這是真的嗎?
事實上感冒第二天、第三天鼻涕本來就會開始變黃。以下是正確的細菌性鼻竇炎診斷標準:
美國小兒科醫學會細菌性鼻竇炎診斷標準
Clinicians should make a presumptive diagnosis of acute bacterial sinusitis when a child with an acute URI presents with the following:
· Persistent illness, ie, nasal discharge (of any quality) or daytime cough or both lasting more than 10 days without improvement;
· 咳嗽流鼻水,超過10天以上沒有改善。
OR
· Worsening course, ie, worsening or new onset of nasal discharge, daytime cough, or fever after initial improvement;
· 症狀比較好後在第6天左右又加重
OR
· Severe onset, ie, concurrent fever (temperature ≥39°C/102.2°F) and purulent nasal discharge for at least 3 consecutive days (Evidence Quality: B; Recommendation).
發燒39度以上加上膿鼻涕超過三天
黃鼻涕不在診斷標準內
美國耳鼻喉醫學會成人細菌性鼻竇炎診斷標準
A clinician should diagnose ABRS when
(a) symptoms or signs of ARS (purulent nasal drainage accompanied by nasal obstruction, facial pain-pressurefullness, or both) persist without evidence of improvement for at least 10 days beyond the onset of upper respiratory symptoms, or
(b) symptoms or signs of ARS worsen within 10 days after an initial improvement (double worsening).
黃鼻涕不在診斷標準內
再次強調,不論是大人或小孩感冒在第2-3天鼻涕本來就會變黃,感冒常是7-10天的病程,加抗生素不會好得比較快喔。