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This week’s case-based question:
As of the year 2017, a total of 3 guidelines inform the emergency treatment of acute sinusitis. These guidelines are from the following medical organizations:
- American Academy of Otolaryngology-Head and Neck Surgery Foundation (published 2015)
- American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma & Immunology (published 2014)
- Infectious Diseases Society of America (published 2012)
All of these guidelines encourage the differentiation between acute bacterial and nonbacterial sinusitis and the judicious use of antibiotics. However, translating this guidance into a clinical goal of limiting antibiotics to patients with bacterial sinusitis is difficult because the distinction between bacterial and nonbacterial sinusitis during a patient’s initial visit is fairly inaccurate. Only the 2015 guidelines provide specific antibiotic recommendations that take this the diagnostic ambiguity into consideration.
What do they state about treating acute sinusitis in adults?
Analgesics and/or nasal saline irrigation may be offered to all patients with acute sinusitis; systemic or intranasal steroids should be reserved for patients strongly suspected of having acute viral sinusitis.
If the decision is made to treat acute sinusitis with an antibiotic, then amoxicillin with clavulanate for 14 days is the first-line therapy in most adults.
If acute bacterial sinusitis is confirmed in a patient whose condition is being managed with observation, then antibiotic therapy should commence only if symptoms are worsening at that point.
When uncomplicated bacterial rhinosinusitis is suspected, watchful waiting should be offered only when there is assurance of follow-up. Otherwise, antibiotics should be started.
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