Este protocolo aborda la rinosinusitis bacteriana aguda (ABRS) no complicada en adultos en la que se ha confirmado hipersensibilidad tipo 1 a la penicilina, una situación clínicamente específica que afecta directamente la conducta terapéutica.
El ABRS se diagnostica cuando los síntomas —secreción nasal purulenta con obstrucción nasal o dolor/presión facial— persisten al menos 10 días sin mejoría, o empeoran tras una mejora inicial (empeoramiento doble). El rasgo distintivo de este escenario es la hipersensibilidad confirmada tipo 1 a la penicilina.
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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