What are the AAO-HNSF treatment guidelines for acute sinusitis (sinus infection)?

Updated: Mar 01, 2018
  • Author: Itzhak Brook, MD, MSc; Chief Editor: Michael Stuart Bronze, MD  more...
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The 2015 updated guidelines by the American Academy of Otolaryngology--Head and Neck Surgery Foundation now recommends watchful waiting for initial management of all patients with uncomplicated acute bacterial rhinosinusitis, regardless of severity, [30] and not just for those with "mild" illness, as in the 2007 guideline. [29] In addition, the recommendation for the preferred agent when antibiotics are prescribed is now amoxicillin with or without clavulanate [30] , whereas the 2007 guideline called for amoxicillin alone. [29]

Other recommendations include the following: [30]

  • Clinicians should not obtain radiographic imaging in patients who meet diagnostic criteria for acute rhinosinusitis, unless a complication or alternative diagnosis is suspected.
  • Clinicians may recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation for symptomatic relief of viral rhinosinusitis or acute bacterial rhinosinusitis (ABRS).
  • If the patient fails to improve with the initial management option by 7 days after diagnosis or worsens during the initial management, the clinician should reassess the patient to confirm ABRS, to exclude other causes of illness, and to detect complications. If ABRS is confirmed in a patient who was initially managed with observation, the clinician should begin antibiotic therapy. If the patient was initially managed with an antibiotic, the clinician should change the antibiotic.

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