What are the diagnostic criteria for acute bacterial rhinosinusitis (ABRS)?

Updated: Apr 22, 2020
  • Author: Ted L Tewfik, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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A clinician should diagnose ABRS when symptoms or signs of ARS either:

  • Persist without evidence of improvement for at least 10 days beyond the onset of upper respiratory symptoms
  • Worsen within 10 days after an initial improvement (double worsening)

In addition, the AAO-HNSF guidelines recommend against radiographic imaging for patients who meet diagnostic criteria for ARS unless a complication or alternative diagnosis is suspected. [14]

IDSA guidelines

In the 2012 IDSA guidelines, a diagnosis of ABRS is made in the presence of any of the following clinical presentations [15] :

  • Onset with persistent symptoms or signs compatible with ARS lasting for at least 10 days without evidence of improvement
  • Onset with severe symptoms or signs of high fever (≥39°C) and purulent nasal discharge or facial pain lasting for at least 3-4 consecutive days at the beginning of illness 
  • Onset with worsening symptoms characterized by the new onset of fever, headache, or increase in nasal discharge following a typical viral upper respiratory infection that lasted 5-6 days, with the signs and symptoms having initially shown improvement

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