What are the AAO-HNSF guidelines on treatment for acute sinusitis?

Updated: Apr 22, 2020
  • Author: Ted L Tewfik, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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AAO-HNSF recommendations for treatment include the following [14] :

  • For both viral and bacterial rhinosinusitis, analgesics, topical intranasal steroids, and/or nasal saline irrigation for symptomatic relief may be offered to patients

  • Offer either watchful waiting (without antibiotics) or prescribe initial antibiotic therapy for adults with uncomplicated ABRS; watchful waiting should be offered only when there is assurance of follow-up so that antibiotic therapy can be started if the patient's condition fails to improve within 7 days of the diagnosis or if it worsens at any time

  • If ABRS is being treated with an antibiotic, amoxicillin, with or without clavulanate, should be first-line therapy for 5-10 days in most adults

  • Reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications if the patient worsens or fails to improve with the initial management option by 7 days after diagnosis or worsens during the initial management; if ABRS is confirmed in a patient being managed with observation, antibiotic therapy should commence; if the patient is already being managed with an antibiotic, the antibiotic should be changed

  • Distinguish chronic rhinosinusitis and RARS from isolated episodes of ABRS and other causes of sinonasal symptoms

  • Assess the patient with chronic rhinosinusitis or RARS for multiple chronic conditions that would modify management, such as asthma, cystic fibrosis, immunocompromised state, and ciliary dyskinesia

  • Obtain testing for allergy and immune function in a patient with RARS.

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