Treatment of Acute Bacterial Rhinosinusitis with Confirmed Type-1 Penicillin Hypersensitivity
Clinical Scenario
This protocol applies to uncomplicated acute bacterial rhinosinusitis (ABRS) in patients with a confirmed type-1 penicillin hypersensitivity. ABRS is diagnosed when symptoms — purulent nasal drainage with nasal obstruction or facial pain/pressure/fullness — persist for at least 10 days without improvement, or worsen after an initial improvement (double worsening). When type-1 penicillin allergy is confirmed, standard penicillin-based empiric therapy is not appropriate.
Treatment Approach
The protocol designates a specific alternative empiric antimicrobial agent — from a class other than penicillins — for a short defined course. The full regimen, including agent selection, duration, and clinical decision points, is available in the structured protocol.
Clinical Goal
Signs and symptoms of acute bacterial rhinosinusitis should generally improve within 3 to 5 days after initiating 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).
- When type-1 penicillin hypersensitivity is confirmed, doxycycline (100 mg or 200 mg PO bid) is recommended as an alternative agent for empiric antimicrobial therapy.
- 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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