Guidelines for the treatment of acute bacterial rhinosinusitis (ABRS) have been released from the Infectious Disease Society of American (IDSA). Although it is difficult to distinguish viral from bacterial acute rhinosinusitis (ARS), three features suggest the diagnosis of ABRS:
- 1) persistent symptoms or signs of ARS lasting 10 or more days with no clinical improvement;
- 2) onset with severe symptoms (fever >39°C or 102°F and purulent nasal discharge or facial pain) lasting at least three consecutive days at the beginning of illness; or
- 3) onset with worsening symptoms following a viral upper respiratory infection that lasted five to six days and was initially improving.
Patients who meet criteria for ABRS should be treated with an antibiotic.
In light of increasing microbial resistance, we no longer recommend treatment with amoxicillin, macrolides (clarithromycin or azithromycin), trimethoprim-sulfamethoxazole, or oral second- or third-generation cephalosporins as initial therapy for ABRS. We agree with the new guidelines in advising an empiric course of amoxicillin-clavulanate (500 mg/125 mg orally three times daily or 875 mg/125 mg orally twice daily) for five to seven days for most patients; doxycycline is a reasonable alternative. Doxycycline or a respiratory fluoroquinolone may be used in patients with penicillin allergy.
Source :
Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012; 54:e72.