Treatment of Uncomplicated Acute Bacterial Rhinosinusitis with Purulent Nasal Discharge (No Penicillin Allergy)
Clinical Scenario
This protocol addresses adults with uncomplicated acute bacterial rhinosinusitis (ABRS) who present with purulent nasal discharge accompanied by nasal obstruction and/or facial pain-pressure-fullness, and who have no penicillin allergy. It applies when symptoms persist without improvement for at least 10 days, or when they worsen within 10 days after an initial improvement (double worsening).
Defining the Condition
ABRS is diagnosed on clinical grounds when purulent nasal discharge with nasal obstruction, facial pain-pressure-fullness, or both meets the duration and progression criteria above. Uncomplicated means there is no clinically evident extension of inflammation beyond the paranasal sinuses and nasal cavity — no neurologic, ophthalmologic, or soft tissue involvement.
Treatment Approach
When antibiotic therapy is warranted, first-line management involves an oral penicillin-class antibiotic — with or without a beta-lactamase inhibitor — selected based on individual patient risk profile. The complete regimen, including selection criteria and duration, is in the full protocol.
Goal: Signs and symptoms should generally improve within 3 to 5 days after starting antibiotic therapy.
References
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).
- If a decision is made to treat ABRS with an antibiotic agent, the clinician should prescribe amoxicillin with or without clavulanate as first-line therapy for 5-7 days for most adults.
- The purpose of this statement is to emphasize that signs and symptoms of presumed ABRS should generally improve within 3 to 5 days after initiating antibiotic therapy.
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