Clinical Practice Guideline
(Affirmation of Value, April 2020)
The guideline, Adult Sinusitis, was developed by the American Academy of Oyolaryngology-Head and Neck Surgery and was reviewed and categorized as Affirmation of Value by the American Academy of Family Physicians.
- Acute bacterial rhinosinusitis (ABRS) should be distinguished from acute rhinosinusitis due to viral respiratory infections and noninfectious conditions. ABRS should be diagnosed when signs and symptoms of acute rhinosinusitis (ARS) (purulent nasal drainage plus nasal obstruction, facial pain-pressure or both) persist without improvement for at least 10 days or if signs and symptoms worsen within 10 days after initial improvement.
- Radiographic imaging should not be performed in patients with ARS unless a complication or alternative diagnosis is suspected.
- Analgesics, intranasal steroids and/or nasal saline irrigation may be recommended for symptomatic relief of viral or bacterial rhinosinusitis.
- Adults with uncomplicated ABRS should be either offered watchful waiting or prescribed antibiotic therapy. Patients undergoing watchful waiting should be prescribed antibiotics if their symptoms fail to improve after 7 days or worsen at any time.
- If a decision is made to treat ABRS with antibiotics, amoxicillin with or without clavulanate should be prescribed as first-line therapy for 5-10 days. Amoxicillin with clavulanate should be prescribed for patients at high risk of being infected by an organism resistant to amoxicillin.
- Patients with an allergy to penicillin should be prescribed doxycycline or a respiratory quinolone as first-line therapy.
- For patients who fail to improve or worsen by 7 days following initial treatment, they should be reassessed to confirm the diagnosis and to detect complications. If initial treatment involved watchful waiting, antibiotics should be prescribed. If initial treatment included an antibiotic, a different antibiotic should be prescribed.
- Chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis should be distinguished from isolated episode of ABRS.
- The diagnosis of CRS should be confirmed with documentation of sinonasal inflammation using anterior rhinoscopy, nasal endoscopy, or computed tomography.
- Saline nasal irrigation, intranasal corticosteroids, or both should be prescribed for symptom relief in patients with CRS.
- Testing for allergy and immune function may be obtained when evaluating a patient with for CRS or recurrent ARS.
Read the full recommendation which includes a treatment algorithm and more information about antibiotic choices.
These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.