Acute Bacterial Rhinosinusitis Diagnosis and Management

Diagnosis

The American College of Allergy, Asthma, and Immunology recommends that a diagnosis of acute bacterial rhinosinusitis (ABRS) be considered in patients with symptoms lasting more than 10 days without improvement, purulent nasal discharge, facial pain/pressure, and postnasal drainage 1, 2, 4, 5
The presence of purulent nasal discharge, facial pain/pressure, and postnasal drainage are cardinal features of bacterial sinusitis, according to the Infectious Diseases Society of America 1, 4, 5
Nasal obstruction, as evidenced by swollen turbinates, confirms significant sinus ostia compromise, as noted by the American Academy of Otolaryngology 1, 4

The most common bacterial pathogens in ABRS are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, as identified by the Infectious Diseases Society of America 4, 5, 6

The Infectious Diseases Society of America recommends prescribing amoxicillin 500mg three times daily or amoxicillin-clavulanate 875mg twice daily for 10 days as first-line therapy for ABRS 6
For patients with penicillin allergy, the American Academy of Allergy, Asthma, and Immunology suggests using a respiratory fluoroquinolone (levofloxacin) or doxycycline 6

The American College of Allergy, Asthma, and Immunology recommends symptomatic relief with first-generation antihistamine/decongestant combination or naproxen 220-440mg twice daily 3
Intranasal saline irrigation can help clear purulent secretions, as suggested by the American Academy of Otolaryngology 1

The American College of Radiology recommends against ordering CT or plain radiographs for uncomplicated ABRS, as it does not change management 7

The Infectious Diseases Society of America recommends reassessing patients in 3-5 days if symptoms worsen or fail to improve, and considering treatment failure if no improvement is seen after 72 hours of antibiotic therapy 2, 3, 6