This protocol covers the initial management of uncomplicated acute bacterial rhinosinusitis (ABRS) presenting with purulent nasal drainage, in a patient without penicillin allergy.
The presentation is purulent nasal drainage accompanied by nasal obstruction, facial pain-pressure-fullness, or both — either persisting without improvement for at least 10 days from the onset of upper respiratory symptoms, or worsening within 10 days after an initial improvement (double worsening). There is no clinically evident extension of inflammation beyond the paranasal sinuses and nasal cavity: no neurologic, ophthalmologic, or soft-tissue involvement. The patient has no penicillin allergy.
The guideline-recommended initial strategy centres on watchful waiting without antibiotics, supported by symptomatic and supportive measures. The full protocol details the precise conditions, duration, and the complete set of recommended supportive interventions.
DOI: 10.1002/ohn.1344
A clinician should diagnose ABRS when (a) symptoms or signs of acute rhinosinusitis (purulent nasal drainage accompanied by nasal obstruction, facial pain-pressure-fullness, or both) persist without evidence of improvement for at least 10 days beyond the onset of upper respiratory symptoms, or (b) symptoms or signs of acute rhinosinusitis worsen within 10 days after an initial improvement (double worsening).
Uncomplicated rhinosinusitis is defined as rhinosinusitis without clinically evident extension of inflammation outside the paranasal sinuses and nasal cavity at the time of diagnosis (e.g., no neurologic, ophthalmologic, or soft tissue involvement).
Clinicians should offer watchful waiting (without antibiotics) for adults with uncomplicated ABRS with assurance of follow-up.
Specific to this CPG update, watchful waiting for ABRS is clarified as lasting 3 to 5 days after diagnosis of ABRS in contrast to a potential 7 days after diagnosis in prior guidelines.
Clinicians may recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation for symptomatic relief of ABRS.
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