What patient education should be provided for acute bacterial rhinosinusitis, including symptoms, treatment options, supportive care, warning signs, and follow‑up?

Patient Education for Acute Bacterial Rhinosinusitis

Understanding Your Diagnosis

Most sinus infections are viral and resolve on their own within 7-10 days without antibiotics—only 0.5-2% are actually bacterial. 1

Your diagnosis of acute bacterial rhinosinusitis was made because you have one of these patterns: 1

• Persistent symptoms ≥10 days without improvement (purulent nasal discharge with facial pressure or nasal obstruction)
• Severe symptoms ≥3-4 consecutive days (fever ≥39°C/102°F with purulent discharge and facial pain)
• "Double sickening"—you initially improved from a cold, then worsened after 5-6 days

What to Expect During Treatment

You should notice improvement within 3-5 days of starting antibiotics; if you don't improve by then, contact your doctor immediately. 1, 2

• By day 3-5: fever should decrease, facial pain should lessen, and purulent drainage should reduce 2
• By day 7: most patients feel significantly better 2
• Complete resolution typically occurs by 10-14 days 1, 2

If you worsen at any time or show no improvement by 3-5 days, you must return for reassessment—this may indicate treatment failure or complications. 1, 2

Your Antibiotic Treatment

Take your prescribed antibiotic (typically amoxicillin-clavulanate 875 mg/125 mg twice daily) for the full 5-10 days, even after you feel better. 1, 2

• Stopping early leads to relapse and promotes antibiotic resistance 1, 2
• Continue until you've been symptom-free for 7 consecutive days 1, 2
• Common side effect: diarrhea occurs in 40-43% of patients taking amoxicillin-clavulanate; severe diarrhea occurs in 7-8% 2

If you have a penicillin allergy, your doctor prescribed an alternative (cephalosporin or fluoroquinolone) based on your allergy type. 1

Essential Supportive Care (Do These for Everyone)

Add these therapies to your antibiotics—they significantly improve symptom relief and speed recovery: 1, 2

Intranasal Corticosteroids (Strongest Evidence)

• Use mometasone, fluticasone, or budesonide nasal spray twice daily 1, 2
• Reduces inflammation and accelerates symptom resolution 1, 2
• Supported by multiple high-quality randomized trials 1, 2

Saline Nasal Irrigation

• Rinse 2-3 times daily with saline solution 1, 2
• Clears mucus and provides immediate symptomatic relief 1, 2

Pain and Fever Control

• Take acetaminophen or ibuprofen as needed for facial pain, headache, and fever 1, 2

Decongestants (Optional)

• Oral pseudoephedrine or topical oxymetazoline may help severe congestion 1, 3
• Limit topical decongestants to ≤3 days to avoid rebound congestion 1, 3

General Measures

• Stay well-hydrated 2
• Apply warm compresses to your face for comfort 2
• Sleep with your head elevated 2

Warning Signs—Seek Immediate Care If You Develop:

These symptoms suggest serious complications requiring urgent evaluation: 1, 2

• Severe headache or stiff neck (possible meningitis)
• Visual changes, eye pain, or swelling around the eye (possible orbital cellulitis)
• Altered mental status or confusion (possible brain abscess)
• High fever that persists despite antibiotics
• Worsening symptoms at any time during treatment

When to Follow Up

Scheduled reassessment at 3-5 days: 1, 2

• Your doctor will check if the antibiotic is working
• If no improvement, you'll switch to a different antibiotic

Contact your doctor if: 1, 2

• No improvement by day 3-5
• Symptoms worsen at any time
• You develop any warning signs listed above
• Symptoms persist beyond 7 days of appropriate treatment

What Antibiotics Do NOT Do

Antibiotics only work for bacterial infections—they provide no benefit for viral colds and cause unnecessary side effects. 1, 4

• 98-99.5% of acute sinus symptoms are viral 1
• Antibiotics do not prevent complications like asthma exacerbations or ear infections in viral cases 5, 6
• Unnecessary antibiotic use promotes resistance, making future infections harder to treat 1

Why You May Not Have Received Antibiotics Immediately

Watchful waiting for 7 days without antibiotics is equally appropriate for uncomplicated cases when reliable follow-up is assured. 1, 2

• Most bacterial sinus infections resolve without antibiotics (73% spontaneous improvement) 2
• The number needed to treat with antibiotics is 10-15 to get one additional person better 1, 2
• This approach reduces unnecessary antibiotic exposure while maintaining safety 1, 2

Recurrent or Chronic Sinusitis

If you have ≥3 episodes per year, you need evaluation for underlying causes: 1, 2, 7

• Allergic rhinitis
• Immunodeficiency
• Anatomic abnormalities (deviated septum, polyps)
• Asthma

Your doctor may refer you to an otolaryngologist (ENT specialist) or allergist for comprehensive evaluation. 1, 2, 7

Key Pitfalls to Avoid

• Do not stop antibiotics early even if you feel better—complete the full course 1, 2
• Do not use topical decongestants >3 days—this causes rebound congestion 1, 3
• Do not expect immediate improvement—antibiotics take 3-5 days to work 1, 2
• Do not assume colored mucus means you need antibiotics—this occurs in viral infections too 2, 8

Hand Hygiene and Prevention

Frequent handwashing is the most effective way to prevent spreading respiratory infections to others. 6