Acute sinusitis (rhinosinusitis) is a common presenting complaint in primary and acute care settings. The vast majority of cases are self limited; but some benefit from antibiotics is likely present in selected cases.
Important diagnostic/treatment considerations:
- In most cases, duration of symptoms >=10 days (that are not improving) is recommended before antibiotics are considered
- Some cases that have escalating symptoms after 5-7 days may warrant antibiotic treatment; these symptoms include:
- Purulent nasal discharge
- Maxillary tooth or facial pain (especially unilateral)
- Unilateral sinus tenderness
- In children (Indications for antibiotics at <10 days of symptoms)
- High fever
- Purulent nasal discharge for at least 3-4 days
- Unilateral facial pain
- Peri-orbital swelling (also consider periorbital cellulitis - meningitis)
- The color and characteristics of the nasal discharge do not predict whether a bacterial pathogen is present (the time course and lack of improvement or increasing severity of symptoms is a better able to determine bacterial etiology)
- Radiographs/CT's are generally not indicated in most cases as clinical judgment is cost effective and appropriate (90% of CT's of sinuses done in first 48-96 hours of a viral URI are abnormal typically in the maxillary sinuses)
- Coverage of Streptococcus pneumoniae and drug resistant S. pneumoniae is essential
- Treatment courses should be 7-10 days
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