Acute SinusitisClinical Guideline Knowledge Check
Sinusitis and rhinosinusitis refer to inflammation in the nasal cavity and paranasal sinuses. Acute rhinosinusitis (ARS) lasts less than four weeks. The most common etiology of ARS is a viral infection associated with the common cold. Distinguishing acute viral rhinosinusitis related to colds and influenza-like illnesses from bacterial infection is a frequent challenge to the primary care clinician.
Acute rhinosinusitis is a common diagnosis, accounting for approximately 30 million primary care visits and $11 billion in healthcare dollars spent annually. It is also a common reason for antibiotic prescriptions in the United States. Due to recent guidance covering concerns for antibiotic resistance and the judicious use of antibiotics, it is essential to have clear guidelines available for such a common diagnosis.
Various 2012-2019 Guidelines (all still valid in 2019) provide sometimes conflicting recommendations for treating acute uncomplicated rhinosinusitis. However, all agree on certain treatment aspects. Let's break it down.
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Today’s Guideline Knowledge Check question comes from the desk of Med-Challenger Emergency Medicine Editor-in-Chief, Andrea Eberly, MD, FAAEM.
Try this acute sinusitis review question and find out if you’re following the most current guidelines for the treatment of acute uncomplicated sinusitis.
A 23-year-old woman complains of cold symptoms, facial pressure over her maxillary sinuses, and a purulent nasal discharge.
On examination, she is febrile, congested, and has facial pain over both of her maxillary sinuses.
The remainder of her vital signs and exam are normal.
Which of the following additional pieces of history/exam findings is an indication for discharging the patient with antibiotics (or at least “watchful waiting” with an option of antibiotics)?
The patient presents with a fever ≥ 39 °C (≥102 °F).
The patient is experiencing a worsening fever, headache, and purulent nasal discharge after improving from her initial cold that started 5 days ago.
Since the onset of her cold with fever and sinusitis symptoms, 7 days have passed without improvement.
On physical exam, the patient is noted to have erythema and induration over the area of her right maxillary sinus.
See the Answer:
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About the Author:
Andrea Eberly, MD, FAAEM graduated from the David Geffen Medical School of Los Angeles (UCLA) and completed her residency in Emergency Medicine at the University Medical Center, Tucson, Arizona. After working as an attending physician in Tucson, she followed a recruiting call to the island of Guam, where she served in various roles, including as the director of the emergency department, the EMS Medical Director of Guam, and the Director of the 911 Call System. She has maintained her emergency medicine board certification through three cycles of American Board of Emergency Medicine Board Exams (last in 2014), all three with the help of Med-Challenger.