Viral etiology > 98%, antibiotics NOT typically recommended.
A clinician should only diagnose acute bacterial rhinosinusitis (ABRS) when symptoms or signs of acute rhinosinusitis:
- are present 10 days or more beyond the onset of upper respiratory symptoms; OR
- worsen within 10 days after an initial improvement (double worsening).
Recommended therapy (7 day duration)
Amoxicillin 500 mg PO TID
Penicillin allergic (rash)
Cefuroxime axetil 500 mg PO BID
Severe pen-allergy or cephalosporin allergy (e.g. anaphylaxis, angioedemia)
Doxycycline 100 mg PO BID or Clarithromycin 500 mg PO BID or TMP/SMX 1 DS tab PO BID
- S. pneumoniae susceptibility: Amoxicillin (98%), cefuroxime (92%), TMP/SMX (72%) & erythromycin (75%).
Complex or Chronic
Refer to BUGS & DRUGS OR Consult with Medical Microbiology / Infectious Disease and strongly consider an ENT consult.
- Failure of First-line Agents
- Clinical deterioration after 72 h of antibiotic therapy.
- No improvement post therapy.
- Acute Recurrent
- More than 3 episodes / year and each episode is 10 or more days in duration.
- Complete resolution between episodes.
- Symptoms last for 12 or more weeks.