This protocol addresses uncomplicated acute bacterial rhinosinusitis (ABRS) in adults where type-1 penicillin hypersensitivity has been confirmed — a clinically specific situation that directly affects how management proceeds.
ABRS is diagnosed when symptoms — purulent nasal drainage with nasal obstruction or facial pain/pressure — persist for at least 10 days without improvement, or worsen after an initial improvement (double worsening). The defining feature of this scenario is confirmed type-1 penicillin hypersensitivity.
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).
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 (Figure 3) 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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