What are the Canadian clinical practice treatment guidelines for acute bacterial rhinosinusitis (RS)?

Updated: Mar 01, 2018
  • Author: Itzhak Brook, MD, MSc; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

The Canadian clinical practice guidelines for acute bacterial rhinosinusitis based the diagnosis of acute bacterial sinusitis on the presence of specific symptoms and their duration; imagining or cultures are not needed in uncomplicated cases. [36] The guidelines for treatment depend on symptom severity and recommend intranasal corticosteroids (INCSs) as monotherapy for mild and moderate cases, although the benefit might be modest. The use of INCSs plus antibiotics is reserved for patients who fail to respond to INCSs after 72 hours and for initial treatment of patients with severe symptoms. The guidelines recommended that antibiotic selection must account for the suspected pathogen, the risk of resistance, comorbid conditions, and local antimicrobial resistance trends. Adjunctive therapies such as nasal saline irrigation are recommended. Failure to respond to treatment, recurrent episodes, and signs of complications should prompt referral to an otolaryngologist.


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