From the Guidelines
Acute sinusitis is best treated with supportive care for 7-10 days, including nasal saline irrigation, intranasal corticosteroids, and analgesics like acetaminophen or ibuprofen for pain relief, as most cases are viral in origin and resolve spontaneously. The treatment approach should prioritize symptomatic relief and watchful waiting before considering antibiotics, as the use of antibiotics is generally not needed for uncomplicated cases 1.
Key Considerations
- The majority of acute sinusitis cases are caused by viral infections, and therefore, antibiotics are not necessary for treatment unless symptoms persist or worsen 1.
- Supportive care measures such as nasal saline irrigation, intranasal corticosteroids (e.g., fluticasone 1-2 sprays per nostril daily), and analgesics (e.g., acetaminophen or ibuprofen) are recommended for symptom relief 1.
- Antibiotics may be considered if symptoms persist beyond 10 days, worsen after initial improvement, or include high fever (>102°F/39°C) with severe facial pain, with amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days) being a typical first-line choice 1.
- For penicillin-allergic patients, doxycycline (100 mg twice daily) or a respiratory fluoroquinolone may be used as alternative antibiotic options 1.
- Decongestants like pseudoephedrine can provide temporary relief but should not be used for more than 3 days to avoid rebound congestion 1.
Management Strategy
- Patients should be educated about the chosen treatment strategy and the rationale behind it, including the potential benefits and harms of antibiotic therapy 1.
- Symptomatic treatment and reassurance are the preferred initial approach for patients with mild symptoms, with antibiotics reserved for those with severe or persistent symptoms 1.
- Patients who are seriously ill, deteriorate clinically despite antibiotic therapy, or have recurrent episodes should be referred to a specialist for further evaluation and management 1.
From the Research
Definition and Prevalence of Acute Sinusitis
- Acute sinusitis is defined pathologically as transient inflammation of the mucosal lining of the paranasal sinuses lasting less than 4 weeks 2.
- It affects 1-5% of the adult population each year in Europe 2.
- In the United States, sinusitis affects 1 in 7 adults, resulting in about 31 million individuals diagnosed each year 3.
Clinical Characteristics
- Clinically, acute sinusitis is characterized by nasal congestion, rhinorrhoea, facial pain, hyposmia, sneezing, and, if more severe, additional malaise and fever 2.
- The term rhinosinusitis is preferred since sinusitis almost always involves the nasal cavity 3.
Diagnosis and Management
- The diagnosis of acute bacterial rhinosinusitis (ABRS) should be made when symptoms or signs of acute rhinosinusitis are present 10 days or more beyond the onset of upper respiratory symptoms, or when symptoms or signs of acute rhinosinusitis worsen within 10 days after an initial improvement (double worsening) 3.
- The management of ABRS should include an assessment of pain, with analgesic treatment based on the severity of pain 3.
- Amoxicillin is recommended as first-line therapy for most adults with ABRS 3.
- Radiographic imaging is not recommended for patients who meet diagnostic criteria for acute rhinosinusitis, unless a complication or alternative diagnosis is suspected 3.
Treatment Options
- Various treatment options are available, including antibiotics, antihistamines, decongestants, saline nasal washes, steam inhalation, and topical corticosteroids 2.
- The effectiveness and safety of these interventions have been evaluated in systematic reviews and studies 2, 3.
- Observation without use of antibiotics is an option for selected adults with uncomplicated ABRS who have mild illness and assurance of follow-up 3.
Chronic Rhinosinusitis
- Chronic rhinosinusitis (CRS) and recurrent acute rhinosinusitis should be distinguished from isolated episodes of ABRS and other causes of sinonasal symptoms 3.
- Computed tomography of the paranasal sinuses is recommended in diagnosing or evaluating a patient with CRS or recurrent acute rhinosinusitis 3.
- Clinicians should educate/counsel patients with CRS or recurrent acute rhinosinusitis regarding control measures 3.