Materiały źródłowe

• #1 Acute sinusitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-sinusitis/diagnosis-treatment/drc-20351677

  Most cases of acute sinusitis get better on their own. Self-care is usually all that’s needed to ease symptoms. […] The following might help ease sinusitis symptoms: […] Saline nasal spray. Salt water sprayed into the nose many times a day rinses the inside of the nose. […] Nasal corticosteroids. These nasal sprays help prevent and treat swelling. […] Decongestants. These medicines are available with and without a prescription. […] Allergy medicines. For sinusitis caused by allergies, using allergy medicines might lessen allergy symptoms. […] Pain relievers. Try acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or aspirin available without a prescription. […] Antibiotics don’t treat viruses, which are the usual cause of acute sinusitis. […] But, if you have severe, worsening or long-lasting symptoms, your symptoms might need to be treated with antibiotics. […] For sinusitis caused or made worse by allergies, allergy shots might help. This is known as immunotherapy. […] No alternative therapies have been proved to ease the symptoms of acute sinusitis.

• #2 Acute Sinusitis: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/15285-acute-sinusitis

  Acute sinusitis often goes away without prescription medication. […] It may take some time for your sinuses to clear but there many things you can do to ease sinus pressure: […] A healthcare provider may prescribe antibiotics if you have acute sinusitis from a bacterial infection. […] Often, providers will take a wait-and-see approach before prescribing antibiotics. […] In general, acute sinusitis symptoms that last 10 or more days may be signs of bacterial infection. […] If you think you have acute sinusitis, ask a healthcare provider to recommend over-the-counter medications and other self-care tips.

• #3 Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment

  Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment […] Treatment for acute viral rhinosinusitis (AVRS) focuses on symptomatic management, as it typically resolves within 7 to 10 days. Bacterial infection occurs in only 0.5 to 2 percent of episodes of ARS. Acute bacterial rhinosinusitis (ABRS) may also be a self-limited disease. Patients may be treated symptomatically and observed or treated with antibiotics. Rarely, patients with ABRS develop serious complications. […] Symptomatic therapy is the mainstay of treatment for acute rhinosinusitis (ARS), as most infections are self-limited regardless of viral or bacterial etiology. Initial evaluation involves identifying complicated infection, which warrants urgent management, and identifying bacterial infection, which warrants antibiotic therapy in selected patients.

• #4 Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment

  For patients with ARS who do not have alarm symptoms, we suggest over-the-counter analgesics, antipyretics, and saline irrigation for symptomatic management. In addition, some experts, including the author of this topic, routinely use intranasal glucocorticoids for all patients with ARS, although other contributors use this more selectively. Symptomatic management of ARS, both viral and bacterial in etiology, aims to relieve symptoms of nasal obstruction and rhinorrhea as well as systemic signs such as fever. […] We suggest saline nasal irrigation with buffered, physiologic, or hypertonic saline to reduce the need for pain medication and improve overall patient comfort, particularly in patients with frequent sinus infections. It is important that irrigants be prepared from sterile or bottled water, as there have been reports of amebic encephalitis due to tap water rinses.

• #5 Sinusitis: Learn More – Treating acute sinusitis – InformedHealth.org – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK279483/

  Sinusitis typically gets better after one to two weeks, even without treatment. The treatment options include steroid nasal sprays, painkillers and saline (salt water) solutions. It usually doesn’t make sense to use antibiotics. […] Steroid nasal sprays reduce the inflammation in the lining of the sinuses, causing the swelling to go down. Research has shown that these nasal sprays can relieve the symptoms of sinusitis. […] The pain can be treated with acetylsalicylic acid (the drug in medicines like Aspirin), acetaminophen (paracetamol) or ibuprofen. […] Decongestant (anti-swelling) nasal sprays or drops work straight away. They temporarily make it easier to breathe through your nose, helping you to sleep better at night. […] Saline solutions can help to remove the secretions (fluid) in the sinuses. […] Because antibiotics only fight bacteria, and sinusitis is typically caused by viruses, there’s usually no need to take antibiotics.

• #6 Patient education: Acute sinusitis (sinus infection) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acute-sinusitis-sinus-infection-beyond-the-basics

  ACUTE SINUSITIS TREATMENT […] The primary treatment for sinusitis involves symptom relief; antibiotic treatment is only necessary for a small percentage of people. You should speak with your health care provider about whether or not you need antibiotic therapy. Bacterial and viral sinusitis will often improve without antibiotic treatment. […] Symptomatic treatment — Symptomatic treatment of a sinus infection aims to relieve symptoms of discomfort and congestion. These treatments do not shorten the duration of illness. […] Pain relief — Nonprescription pain medications, such as acetaminophen (sample brand name: Tylenol) or ibuprofen (sample brand names: Motrin, Advil), are recommended for pain. […] Nasal irrigation — Flushing the nose and sinuses with a saline solution several times per day can decrease pain associated with congestion and shorten the duration of symptoms. A variety of devices, including syringes, Neti pots, and bottle sprayers, may be used to perform nasal irrigation. Your doctor or pharmacist can recommend a nasal irrigation kit. These are available without a prescription.

• #7 Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment

  For patients with ARS who do not have alarm symptoms, we suggest over-the-counter analgesics, antipyretics, and saline irrigation for symptomatic management. In addition, some experts, including the author of this topic, routinely use intranasal glucocorticoids for all patients with ARS, although other contributors use this more selectively. Symptomatic management of ARS, both viral and bacterial in etiology, aims to relieve symptoms of nasal obstruction and rhinorrhea as well as systemic signs such as fever. […] We suggest saline nasal irrigation with buffered, physiologic, or hypertonic saline to reduce the need for pain medication and improve overall patient comfort, particularly in patients with frequent sinus infections. It is important that irrigants be prepared from sterile or bottled water, as there have been reports of amebic encephalitis due to tap water rinses.

• #8 Acute Sinusitis: Symptoms and Treatment

  https://patient.info/ears-nose-throat-mouth/acute-sinusitis

  Acute sinusitis is a sinus infection which usually goes away on its own without treatment. There are various treatments that may help to ease symptoms. Antibiotic medicines are only needed sometimes. […] Acute sinusitis often clears up without treatment. However, there are several things you can do to treat the symptoms in the meantime. […] If your symptoms persist for more than 10 days your doctor may consider prescribing a high-dose steroid nose spray such as mometasone. […] Not usually. Department of Health guidelines recommend that antibiotics should not be used for at least the first 10 days. […] They may be considered if you become very unwell or if your symptoms persist for more than 10 days and don’t respond to other measures. […] Some treatments may help to relieve symptoms whilst you are waiting for your immune system to clear the infection. These include the following: Painkillers such as paracetamol or ibuprofen will usually ease any pain. […] Decongestant nasal sprays or drops are sometimes used. […] Keeping hydrated can be helpful, so have plenty of drinks. […] Warm face packs held over the sinuses may help to ease pain. […] Saline nasal washing may help to relieve congestion and blockage in the nose.

• #9 Patient education: Acute sinusitis (sinus infection) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acute-sinusitis-sinus-infection-beyond-the-basics

  Nasal steroids — Nasal steroids (steroids delivered by a nasal spray) can help to reduce swelling inside the nose, usually within two to three days. These drugs have few side effects and relieve symptoms in most people. […] There are a number of nasal steroids available by prescription as well as a few that can be purchased without a prescription (over the counter). These drugs are all effective but differ in how frequently they must be used and how much they cost. […] Other treatments […] • Nasal anticholinergics – Ipratropium bromide (delivered by a nasal spray) is available by prescription and can be very effective in decreasing the symptom of runny nose and other related symptoms (eg, post-nasal drainage, sore throat). These sprays, like all medications, can interact with other medications, so it is important that your complete medication list be reviewed by your physician before you take this medication.

• #10 Acute Rhinosinusitis in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0501/p1057.html

  Adjunctive therapies that have been investigated for symptomatic relief of acute bacterial rhinosinusitis include analgesics, decongestants, antihistamines, saline nasal irrigation, mucolytics, and intranasal corticosteroids. […] Intranasal corticosteroids reduce inflammation and edema of the nasal mucosa, nasal turbinates, and sinus ostia. […] If symptoms worsen or fail to improve with treatment, physicians should reevaluate the patient to confirm the diagnosis of acute bacterial rhinosinusitis, exclude other causes of illness, and detect complications.

• #11 Patient education: Acute sinusitis (sinus infection) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acute-sinusitis-sinus-infection-beyond-the-basics

  • Oral decongestants – Oral decongestants (most commonly pseudoephedrine and phenylephrine) may be helpful if you have associated symptoms of ear pain or fullness. […] • Nasal decongestant sprays – Nasal decongestant sprays, including oxymetazoline (Afrin) and phenylephrine (Neo-Synephrine), can be used to temporarily treat congestion. However, these sprays should not be used for more than two to three days due to the risk of rebound congestion (when the nose becomes congested constantly unless the medication is used repeatedly), possible addiction, and long-term consequences of frequent use, including persistent nasal dryness and crusting, which is very difficult to treat once it has developed. […] • Oral antihistamines – Oral antihistamines (such as diphenhydramine/Benadryl) are not proven to improve symptoms of sinusitis and can have unwanted side effects.

• #12 Acute Sinusitis: Symptoms and Treatment

  https://patient.info/ears-nose-throat-mouth/acute-sinusitis

  Acute sinusitis is a sinus infection which usually goes away on its own without treatment. There are various treatments that may help to ease symptoms. Antibiotic medicines are only needed sometimes. […] Acute sinusitis often clears up without treatment. However, there are several things you can do to treat the symptoms in the meantime. […] If your symptoms persist for more than 10 days your doctor may consider prescribing a high-dose steroid nose spray such as mometasone. […] Not usually. Department of Health guidelines recommend that antibiotics should not be used for at least the first 10 days. […] They may be considered if you become very unwell or if your symptoms persist for more than 10 days and don’t respond to other measures. […] Some treatments may help to relieve symptoms whilst you are waiting for your immune system to clear the infection. These include the following: Painkillers such as paracetamol or ibuprofen will usually ease any pain. […] Decongestant nasal sprays or drops are sometimes used. […] Keeping hydrated can be helpful, so have plenty of drinks. […] Warm face packs held over the sinuses may help to ease pain. […] Saline nasal washing may help to relieve congestion and blockage in the nose.

• #13 Patient education: Acute sinusitis (sinus infection) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acute-sinusitis-sinus-infection-beyond-the-basics

  • Mucolytics – Medications to thin secretions (such as guaifenesin) may help to clear mucus. […] • Steam inhalation – Breathing in warm, moist air (steam) may temporarily relieve congestion, but there is no evidence that it will shorten the duration or severity of symptoms. If you choose to try this, be sure that the water you use to make steam is clean and free of mold or other contaminants. […] Observation — Observation (continuing to watch and wait) is an option for treatment for many patients. You should speak with your health care provider about whether or not this is the best option for you. […] Watching and waiting is a reasonable option because up to 75 percent of people with bacterial sinusitis improve within one month without antibiotics. During the watch and wait period, treatments to improve symptoms are recommended. If symptoms worsen with observation, treatment with an antibiotic is usually started.

• #14 Patient education: Acute sinusitis (sinus infection) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acute-sinusitis-sinus-infection-beyond-the-basics

  • Mucolytics – Medications to thin secretions (such as guaifenesin) may help to clear mucus. […] • Steam inhalation – Breathing in warm, moist air (steam) may temporarily relieve congestion, but there is no evidence that it will shorten the duration or severity of symptoms. If you choose to try this, be sure that the water you use to make steam is clean and free of mold or other contaminants. […] Observation — Observation (continuing to watch and wait) is an option for treatment for many patients. You should speak with your health care provider about whether or not this is the best option for you. […] Watching and waiting is a reasonable option because up to 75 percent of people with bacterial sinusitis improve within one month without antibiotics. During the watch and wait period, treatments to improve symptoms are recommended. If symptoms worsen with observation, treatment with an antibiotic is usually started.

• #15 Acute Sinusitis Management

  https://mobile.fpnotebook.com/ENT/Sinus/ActSnstsMngmnt.htm

  Symptomatic relief […] Warm, moist compresses over sinuses […] Tylenol […] Nasal Saline spray (2% buffered saline) or Neti Pot […] Effective Decongestant […] Use pre-prepared solution or filtered, distilled or boiled water […] Non-sterilized tap water rinses have been associated with amebic Encephalitis […] Also use as pretreatment prior to Intranasal Steroid […] Effective in recurrent Sinusitis when used daily […] Mucolytic […] Historically used, but evidence is lacking for benefit […] Overall low side-effect profile and reasonable to trial […] Guaifenesin (e.g. Mucinex) 600 to 1200 mg orally twice daily […] Topical Decongestants (Maximum of 3 days of use) […] Oxymetazoline (Afrin) […] Avoid afrin (Oxymetazoline) in children […] Risk of central alpha-2 Agonist activity (Clonidine-like CNS depression)

• #16 Acute Sinusitis Management

  https://mobile.fpnotebook.com/ENT/Sinus/ActSnstsMngmnt.htm

  Phenylephrine (Neo-Synephrine) […] If a nasal Decongestant is used in children, Neo-Synephrine (Phenylephrine) is preferred […] Systemic Decongestants (e.g Pseudoephedrine) […] Not recommended due to systemic adverse effects and adds little to symptomatic relief over other options […] Avoid in Hypertension and cardiovascular disease […] Limited course may be reasonable for refractory symptoms […] Consider 3 days of Afrin nasal spray for facial pain relief […] Intranasal Steroids (treat for 3-6 weeks minimum if indicated) […] Modest benefit even in Acute Sinusitis without underlying Allergic Rhinitis (NNT 14-15) […] Avoid Antihistamines […] Dry secretions […] Impede osteomeatal complex drainage […] Avoid Systemic Corticosteroids (ineffective, adverse effects) in Acute Sinusitis

• #17 Sinus Infection Basics | Sinus Infection | CDC

  https://www.cdc.gov/sinus-infection/about/index.html

  You do not need antibiotics for many sinus infections. Most sinus infections usually get better on their own without antibiotics. […] However, in some cases, you may need antibiotics. Talk to your healthcare provider about the best treatment for your illness. […] For some sinus infections, your healthcare provider might recommend watchful waiting or delayed antibiotic prescribing. […] Your healthcare provider may suggest watching and waiting for 2-3 days to see if you need antibiotics. This gives the immune system time to fight off the infection. If your symptoms don’t improve, the healthcare provider may prescribe an antibiotic. […] Your healthcare provider may prescribe an antibiotic but suggest that you wait 2-3 days before filling the prescription. You may recover on your own and may not need the antibiotic.

• #18 Antibiotics for Sinusitis: Do They Help? Types, Side Effects, & More

  https://www.webmd.com/allergies/antibiotics

  People with painful sinus problems often plead with their doctors to give them an antibiotic as soon as possible. About 83% of adults seen in the U.S. by a doctor for acute sinusitis end up getting an antibiotic, research shows. And most don’t need it. […] But antibiotics may not always be the best remedy for sinusitis. Your body should be able to cure itself of a mild or moderate sinusitis, and you should avoid antibiotics that can cause antibiotic resistance. […] Many medical guidelines, including those issued jointly by the American Academy of Allergy, Asthma Immunology, the American College of Allergy, Asthma, and Immunology, and the Joint Council of Allergy, Asthma Immunology, now recommend the judicious (cautious) use of antibiotics. […] About 60%-70% of people with sinus infections recover without antibiotics, according to the American Academy of Allergy, Asthma Immunology.

• #19 Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment

  Some experts, including the author of this topic, routinely use intranasal glucocorticoids (eg, mometasone or fluticasone) for all patients with ARS, whereas other experts use this more selectively because of small benefits. Studies have shown small symptomatic benefits and minimal adverse effects with short-term use of intranasal glucocorticoids for patients with both acute viral rhinosinusitis (AVRS) and ABRS. […] We suggest not using systemic glucocorticoids in the treatment of ARS. When given in addition to antibiotics, oral glucocorticoids may shorten the time to symptom resolution or improvement, but the benefits are small and, unlike topical glucocorticoids, systemic glucocorticoids pose a potential risk for side effects that outweighs the clinical benefits. […] In patients with a clinical diagnosis of acute bacterial rhinosinusitis (ABRS), management options include an additional seven-day observation period or initiation of antibiotic therapy. For most patients with clinically diagnosed ABRS, we suggest an additional seven-day observation period without antibiotics (ie, „watchful waiting”).

• #20 Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment

  For patients with any of the following, we have a low threshold to initiate antibiotics at the time of diagnosis: immunocompromising conditions or comorbidities that can affect immune function, multiple comorbidities, unreliable or uncertain follow-up, known anatomic abnormalities, and younger age. […] Antibiotic therapy is appropriate as initial treatment for patients at increased risk for complicated infection, including those with immunocompromising conditions, multiple comorbidities, poor or uncertain follow-up, known anatomic abnormalities, or younger age. […] Initial empiric treatment generally includes amoxicillin or amoxicillin-clavulanate; the choice between these agents and dosing depends on risk factors for bacterial resistance. For patients with ABRS without risk factors for resistant pneumococcus, we suggest treatment with amoxicillin or standard-dose amoxicillin-clavulanate.

• #21 Acute Rhinosinusitis in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0501/p1057.html

  Rhinosinusitis is one of the most common conditions for which patients seek medical care. […] Symptomatic treatment with analgesics, decongestants, and saline nasal irrigation is appropriate in patients who present with nonsevere symptoms (e.g., mild pain, temperature less than 101F [38.3C]). Narrow-spectrum antibiotics, such as amoxicillin or trimethoprim/sulfamethoxazole, are recommended in patients with symptoms or signs of acute rhinosinusitis that do not improve after seven days, or that worsen at any time. […] Limited evidence supports the use of intranasal corticosteroids in patients with acute rhinosinusitis. […] Antibiotic therapy is recommended for patients with rhinosinusitis symptoms that do not improve within seven days or that worsen at any time; those with moderate illness (moderate to severe pain or temperature 101F [38.3C]); or those who are immunocompromised.

• #22 AAO-HNSF Updated Clinical Practice Guideline: Adult Sinusitis – Press Release & Fact Sheet – American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)

  https://www.entnet.org/resource/aao-hnsf-updated-cpg-adult-sinusitis-press-release-fact-sheet/

  Experts Update Best Practices for Treating the 1 in 8 U.S. Adults Suffering from Sinusitis […] Because sinusitis is treated differently based on its cause, it is critical to differentiate between acute viral sinusitis and acute bacterial sinusitis. […] New evidence supports a recommendation of either watchful waiting or antibiotic therapy for mild, moderate, or even severe acute bacterial sinusitis. […] More than 20% of antibiotics prescribed for adults in the U.S. are to treat sinus infections. This updated guideline empowers clinicians and their educated patients to make those treatment decisions together, being more judicious in the use of antibiotics and talking through the options for symptom relief. […] It is important to identify if the cause of sinusitis is bacterial or viral as the treatment is based on the cause. Acute viral sinusitis does not benefit from antibiotic treatment, but acute bacterial sinusitis may.

• #23 Acute Sinusitis Management

  https://mobile.fpnotebook.com/ENT/Sinus/ActSnstsMngmnt.htm

  Premature Antibiotic use (and Antibiotic Overuse) in Acute Sinusitis is common and unwarranted […] Up to 70% of Acute Sinusitis 14 days resolves without Antibiotics […] Number Needed to Treat (NNT) for Antibiotic in Acute Sinusitis benefit: 11-15 […] Number needed to harm (NNH) for Antibiotic in Acute Sinusitis adverse effects: 8 […] Indicated only in acute Bacterial Sinusitis […] Only 10% of Sinusitis cases overall are Bacterial […] Persistent Sinusitis symptoms 10 days (Bacterial in 60% of cases) […] IDSA uses 7 days of persistent symptoms as a treatment indication […] Moderate to severe unilateral facial pain for at least 3-4 days […] May be associated with Maxillary Toothache […] Persistent Fever over 101 to 102 F […] Upper respiratory symptoms for 5 to 6 days that resolved and then recurred (double-Hump Sign)

• #24 Acute Sinusitis Management

  https://mobile.fpnotebook.com/ENT/Sinus/ActSnstsMngmnt.htm

  Premature Antibiotic use (and Antibiotic Overuse) in Acute Sinusitis is common and unwarranted […] Up to 70% of Acute Sinusitis 14 days resolves without Antibiotics […] Number Needed to Treat (NNT) for Antibiotic in Acute Sinusitis benefit: 11-15 […] Number needed to harm (NNH) for Antibiotic in Acute Sinusitis adverse effects: 8 […] Indicated only in acute Bacterial Sinusitis […] Only 10% of Sinusitis cases overall are Bacterial […] Persistent Sinusitis symptoms 10 days (Bacterial in 60% of cases) […] IDSA uses 7 days of persistent symptoms as a treatment indication […] Moderate to severe unilateral facial pain for at least 3-4 days […] May be associated with Maxillary Toothache […] Persistent Fever over 101 to 102 F […] Upper respiratory symptoms for 5 to 6 days that resolved and then recurred (double-Hump Sign)

• #25 Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment

  For patients with any of the following, we have a low threshold to initiate antibiotics at the time of diagnosis: immunocompromising conditions or comorbidities that can affect immune function, multiple comorbidities, unreliable or uncertain follow-up, known anatomic abnormalities, and younger age. […] Antibiotic therapy is appropriate as initial treatment for patients at increased risk for complicated infection, including those with immunocompromising conditions, multiple comorbidities, poor or uncertain follow-up, known anatomic abnormalities, or younger age. […] Initial empiric treatment generally includes amoxicillin or amoxicillin-clavulanate; the choice between these agents and dosing depends on risk factors for bacterial resistance. For patients with ABRS without risk factors for resistant pneumococcus, we suggest treatment with amoxicillin or standard-dose amoxicillin-clavulanate.

• #26 Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment

  For patients with any of the following, we have a low threshold to initiate antibiotics at the time of diagnosis: immunocompromising conditions or comorbidities that can affect immune function, multiple comorbidities, unreliable or uncertain follow-up, known anatomic abnormalities, and younger age. […] Antibiotic therapy is appropriate as initial treatment for patients at increased risk for complicated infection, including those with immunocompromising conditions, multiple comorbidities, poor or uncertain follow-up, known anatomic abnormalities, or younger age. […] Initial empiric treatment generally includes amoxicillin or amoxicillin-clavulanate; the choice between these agents and dosing depends on risk factors for bacterial resistance. For patients with ABRS without risk factors for resistant pneumococcus, we suggest treatment with amoxicillin or standard-dose amoxicillin-clavulanate.

• #27 Acute Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547701/

  Treatment of ABRS consists of either antibiotic therapy or a period of watchful waiting so long as the certainty of reliable follow-up. There are slight variations between different expert committee guidelines. […] The American Academy of Otolaryngology Adult Sinusitis 2015 updated guideline recommends amoxicillin with or without clavulanate in adults as first-line therapy for a period of 5 to 10 days in most adults. Treatment failure is noted if symptoms do not decrease within 7 days or worsen at any time. […] The Infectious Disease Society of America Guidelines for Acute Bacterial Rhinosinusitis recommends amoxicillin with clavulanate in adults as first-line therapy for 10 to 14 days in children and 5 to 7 days in adults. Treatment failure is noted if symptoms do not decrease after 3 to 5 days or worsen after 48 to 72 hours of therapy.

• #28 AAO-HNSF Updated Clinical Practice Guideline: Adult Sinusitis – Press Release & Fact Sheet – American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)

  https://www.entnet.org/resource/aao-hnsf-updated-cpg-adult-sinusitis-press-release-fact-sheet/

  Clinicians should either offer watchful waiting (without antibiotics) or prescribe initial antibiotic therapy for adults with uncomplicated acute bacterial rhinosinusitis. […] If a decision is made to treat acute bacterial rhinosinusitis with an antibiotic agent, the clinician should prescribe amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days for most adults. […] 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 acute bacterial rhinosinusitis, exclude other causes of illness, and detect complications. If acute bacterial rhinosinusitis is confirmed in the patient 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.

• #29 Acute Sinusitis Treatment & Management: Approach Considerations, Symptomatic Treatment, Antimicrobial Therapy

  https://emedicine.medscape.com/article/232670-treatment

  Intranasal steroids have not been conclusively shown to be of benefit in cases of acute sinusitis. […] Antihistamines are not recommended and have not been proven beneficial. […] A 15- to 21-day course of intranasal corticosteroids may reduce symptom duration when compared with placebo. […] Antibiotics are indicated for sinusitis that is thought to be bacterial, including sinusitis that is severe or involves the frontal, ethmoid, or sphenoid sinuses, since this type of sinusitis is more prone to complications. […] A 5- to 10-day regimen of amoxicillin 500 mg 3 times a day is recommended as first-line therapy. […] The most commonly used second-line therapies include amoxicillin-clavulanate, second- or third-generation cephalosporins, macrolides, fluoroquinolones, and clindamycin. […] In patients with dental causes of sinusitis or those with foul-smelling discharge, anaerobic coverage using clindamycin or amoxicillin with metronidazole is necessary.

• #30 Treating acute sinusitis – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/treating-acute-sinusitis-3.html

  Infections in the nose involve the sinuses because the lining of the nose and the paranasal sinuses is continuous. […] Treatment consists of combining topical or systemic decongestants with saline irrigations and an antibiotic, usually amoxycillin. […] There are no good data on the treatment of sinusitis. Common practice includes decongestants which shrink the nasal mucosal oedema and help open the natural ostia of the sinuses and allow re-aeration and muco-ciliary drainage. […] If the diagnostic criteria are strict, acute bacterial sinusitis should be treated with antibiotics as they are significantly more effective than placebo alone. […] Amoxycillin is still considered first-line treatment. The adult dose is amoxycillin 500 mg three times a day for a period of between 10 and 14 days.

• #31 Acute Sinusitis Management

  https://mobile.fpnotebook.com/ENT/Sinus/ActSnstsMngmnt.htm

  Amoxicillin […] Adult: 1000 mg orally twice daily […] Consider Augmentin instead as first-line management in adults […] Child: 90 mg/kg/day divided bid to tid (high dose) […] Disadvantages: Misses Beta-Lactamase producers […] Amoxicillin-Clavulanate (Augmentin): Standard Low Dose […] Recommended as a first-line agent instead of Amoxicillin as of 2015 by IDSA for Acute Bacterial Rhinosinusitis […] Covers Haemophilus Influenzae and Moraxella catarrhalis which Amoxicillin misses […] Child: 45 mg/kg/day divided every 12 hours […] Adult: Augmentin 875 mg orally twice daily (or 500 mg orally three times daily) […] Consider adding Metronidazole (Flagyl) to second-line agents […] Consider second-line agent for longer course (4 week) […] Consider CT Sinuses

• #32 Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment

  For patients with risk factors for resistant pneumococcus, we suggest high-dose amoxicillin-clavulanate. For any patient with a penicillin allergy, doxycycline is a reasonable alternative to amoxicillin or amoxicillin-clavulanate for initial therapy. […] We suggest an initial antibiotic treatment course of five to seven days. We typically give a prescription for seven days but inform patients they can stop after five days if symptoms have improved. […] Patients who have worsening symptoms or do not improve with initial antibiotic therapy should have the diagnosis of ABRS confirmed with clinical reevaluation and imaging if needed; we suggest an alternative antibiotic regimen for patients with confirmed uncomplicated ABRS. […] Patients with persistent symptoms after two courses of appropriate antibiotic therapy warrant referral to an otolaryngology specialist. Additional evaluation typically includes sinus culture and noncontrast CT imaging of the sinuses if not already performed.

• #33 Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment

  For patients with risk factors for resistant pneumococcus, we suggest high-dose amoxicillin-clavulanate. For any patient with a penicillin allergy, doxycycline is a reasonable alternative to amoxicillin or amoxicillin-clavulanate for initial therapy. […] We suggest an initial antibiotic treatment course of five to seven days. We typically give a prescription for seven days but inform patients they can stop after five days if symptoms have improved. […] Patients who have worsening symptoms or do not improve with initial antibiotic therapy should have the diagnosis of ABRS confirmed with clinical reevaluation and imaging if needed; we suggest an alternative antibiotic regimen for patients with confirmed uncomplicated ABRS. […] Patients with persistent symptoms after two courses of appropriate antibiotic therapy warrant referral to an otolaryngology specialist. Additional evaluation typically includes sinus culture and noncontrast CT imaging of the sinuses if not already performed.

• #34 Acute Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547701/

  The American Academy of Pediatrics Clinic Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged to 18 Years recommends amoxicillin with or without clavulanate as first-line therapy. The duration of treatment is unclear, however treating for an additional seven days after symptoms resolve was their suggestion. The criteria for treatment failure is if symptoms do not decrease or worsen after 72 hours of therapy. […] Local antibiotic resistance patterns, the patient’s risk level, risk factors for antibiotic resistance, and severity of symptoms help determine whether to add clavulanate or whether high-dose amoxicillin (90mg/kg/day versus 45mg/kg/day) should be used in children. […] For patients allergic to penicillin, a third-generation cephalosporin plus clindamycin (for adequate coverage of non-susceptible S. pneumoniae) or doxycycline could be therapeutic possibilities.

• #35 Acute Sinusitis Management

  https://mobile.fpnotebook.com/ENT/Sinus/ActSnstsMngmnt.htm

  Consider Otolaryngology Consultation […] Fluoroquinolones (avoid under age 16 years, and those at higher risk of Tendinopathy, Neuropathy) […] Consider Parenteral management in severe cases of hospitalized patients […] Clindamycin (children with Penicillin Allergy) […] Dosing: 30-40 mg/kg/day divided three to four times daily […] Combine with Third Generation Cephalosporin (Cefixime, Cefpodoxime) or Rifampin […] Avoid Clindamycin alone […] Clindamycin has poor efficacy against Gram Negative Bacteria […] Increasing resistance to Haemophilus and Moraxella […] Doxycycline (avoid under age 8 years old) […] Consider in Type I Hypersensitivity to Penicillins, but incomplete Gram Positive coverage […] Dosing: 100 mg orally twice daily for 5-7 days […] Agents that are no longer recommended due to high resistance rates

• #36 Acute Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547701/

  The American Academy of Pediatrics Clinic Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged to 18 Years recommends amoxicillin with or without clavulanate as first-line therapy. The duration of treatment is unclear, however treating for an additional seven days after symptoms resolve was their suggestion. The criteria for treatment failure is if symptoms do not decrease or worsen after 72 hours of therapy. […] Local antibiotic resistance patterns, the patient’s risk level, risk factors for antibiotic resistance, and severity of symptoms help determine whether to add clavulanate or whether high-dose amoxicillin (90mg/kg/day versus 45mg/kg/day) should be used in children. […] For patients allergic to penicillin, a third-generation cephalosporin plus clindamycin (for adequate coverage of non-susceptible S. pneumoniae) or doxycycline could be therapeutic possibilities.

• #37 Sinusitis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/nose-and-paranasal-sinus-disorders/sinusitis

  The first-line antibiotic is amoxicillin/clavulanate, with doxycycline or respiratory fluoroquinolones as alternatives. […] Sinusitis unresponsive to antibiotic therapy may require surgery (maxillary sinusotomy, ethmoidectomy, or sphenoid sinusotomy) to improve ventilation and drainage and to remove inspissated mucopurulent material, epithelial debris, and hypertrophic mucous membrane.

• #38 Acute Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547701/

  Treatment of ABRS consists of either antibiotic therapy or a period of watchful waiting so long as the certainty of reliable follow-up. There are slight variations between different expert committee guidelines. […] The American Academy of Otolaryngology Adult Sinusitis 2015 updated guideline recommends amoxicillin with or without clavulanate in adults as first-line therapy for a period of 5 to 10 days in most adults. Treatment failure is noted if symptoms do not decrease within 7 days or worsen at any time. […] The Infectious Disease Society of America Guidelines for Acute Bacterial Rhinosinusitis recommends amoxicillin with clavulanate in adults as first-line therapy for 10 to 14 days in children and 5 to 7 days in adults. Treatment failure is noted if symptoms do not decrease after 3 to 5 days or worsen after 48 to 72 hours of therapy.

• #39 AAO-HNSF Updated Clinical Practice Guideline: Adult Sinusitis – Press Release & Fact Sheet – American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)

  https://www.entnet.org/resource/aao-hnsf-updated-cpg-adult-sinusitis-press-release-fact-sheet/

  Clinicians should either offer watchful waiting (without antibiotics) or prescribe initial antibiotic therapy for adults with uncomplicated acute bacterial rhinosinusitis. […] If a decision is made to treat acute bacterial rhinosinusitis with an antibiotic agent, the clinician should prescribe amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days for most adults. […] 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 acute bacterial rhinosinusitis, exclude other causes of illness, and detect complications. If acute bacterial rhinosinusitis is confirmed in the patient 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.

• #40 Acute Sinusitis Treatment & Management: Approach Considerations, Symptomatic Treatment, Antimicrobial Therapy

  https://emedicine.medscape.com/article/232670-treatment

  Intranasal steroids have not been conclusively shown to be of benefit in cases of acute sinusitis. […] Antihistamines are not recommended and have not been proven beneficial. […] A 15- to 21-day course of intranasal corticosteroids may reduce symptom duration when compared with placebo. […] Antibiotics are indicated for sinusitis that is thought to be bacterial, including sinusitis that is severe or involves the frontal, ethmoid, or sphenoid sinuses, since this type of sinusitis is more prone to complications. […] A 5- to 10-day regimen of amoxicillin 500 mg 3 times a day is recommended as first-line therapy. […] The most commonly used second-line therapies include amoxicillin-clavulanate, second- or third-generation cephalosporins, macrolides, fluoroquinolones, and clindamycin. […] In patients with dental causes of sinusitis or those with foul-smelling discharge, anaerobic coverage using clindamycin or amoxicillin with metronidazole is necessary.

• #41 Acute Sinusitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK547701/

  Treatment of ABRS consists of either antibiotic therapy or a period of watchful waiting so long as the certainty of reliable follow-up. There are slight variations between different expert committee guidelines. […] The American Academy of Otolaryngology Adult Sinusitis 2015 updated guideline recommends amoxicillin with or without clavulanate in adults as first-line therapy for a period of 5 to 10 days in most adults. Treatment failure is noted if symptoms do not decrease within 7 days or worsen at any time. […] The Infectious Disease Society of America Guidelines for Acute Bacterial Rhinosinusitis recommends amoxicillin with clavulanate in adults as first-line therapy for 10 to 14 days in children and 5 to 7 days in adults. Treatment failure is noted if symptoms do not decrease after 3 to 5 days or worsen after 48 to 72 hours of therapy.

• #42 Patient education: Acute sinusitis (sinus infection) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acute-sinusitis-sinus-infection-beyond-the-basics

  What if I do not improve with treatment? — If you do not improve or if you worsen after a course of antibiotics, you should be re-examined. You may need a different antibiotic or further evaluation with imaging or an examination of the inside of the sinuses. […] In some cases, symptoms of sinusitis improve but then recur. This is usually because the infection was not completely eliminated by the antibiotic. An alternate antibiotic, extended antibiotic treatment, and/or further testing may be recommended, depending upon your individual situation.

• #43 Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment

  For patients with risk factors for resistant pneumococcus, we suggest high-dose amoxicillin-clavulanate. For any patient with a penicillin allergy, doxycycline is a reasonable alternative to amoxicillin or amoxicillin-clavulanate for initial therapy. […] We suggest an initial antibiotic treatment course of five to seven days. We typically give a prescription for seven days but inform patients they can stop after five days if symptoms have improved. […] Patients who have worsening symptoms or do not improve with initial antibiotic therapy should have the diagnosis of ABRS confirmed with clinical reevaluation and imaging if needed; we suggest an alternative antibiotic regimen for patients with confirmed uncomplicated ABRS. […] Patients with persistent symptoms after two courses of appropriate antibiotic therapy warrant referral to an otolaryngology specialist. Additional evaluation typically includes sinus culture and noncontrast CT imaging of the sinuses if not already performed.

• #44 AAO-HNSF Updated Clinical Practice Guideline: Adult Sinusitis – Press Release & Fact Sheet – American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)

  https://www.entnet.org/resource/aao-hnsf-updated-cpg-adult-sinusitis-press-release-fact-sheet/

  Clinicians should either offer watchful waiting (without antibiotics) or prescribe initial antibiotic therapy for adults with uncomplicated acute bacterial rhinosinusitis. […] If a decision is made to treat acute bacterial rhinosinusitis with an antibiotic agent, the clinician should prescribe amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days for most adults. […] 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 acute bacterial rhinosinusitis, exclude other causes of illness, and detect complications. If acute bacterial rhinosinusitis is confirmed in the patient 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.

• #45 Uncomplicated acute sinusitis and rhinosinusitis in adults: Treatment – UpToDate

  https://www.uptodate.com/contents/uncomplicated-acute-sinusitis-and-rhinosinusitis-in-adults-treatment

  Some experts, including the author of this topic, routinely use intranasal glucocorticoids (eg, mometasone or fluticasone) for all patients with ARS, whereas other experts use this more selectively because of small benefits. Studies have shown small symptomatic benefits and minimal adverse effects with short-term use of intranasal glucocorticoids for patients with both acute viral rhinosinusitis (AVRS) and ABRS. […] We suggest not using systemic glucocorticoids in the treatment of ARS. When given in addition to antibiotics, oral glucocorticoids may shorten the time to symptom resolution or improvement, but the benefits are small and, unlike topical glucocorticoids, systemic glucocorticoids pose a potential risk for side effects that outweighs the clinical benefits. […] In patients with a clinical diagnosis of acute bacterial rhinosinusitis (ABRS), management options include an additional seven-day observation period or initiation of antibiotic therapy. For most patients with clinically diagnosed ABRS, we suggest an additional seven-day observation period without antibiotics (ie, „watchful waiting”).

• #46 Sinusitis: From Diagnosis to Treatment – The ObG Project

  https://www.obgproject.com/2023/01/17/sinusitis-from-diagnosis-to-treatment/

  First determine if viral or bacterial etiology […] Acute bacterial rhinosinusitis (ABRS) can be differentiated from acute viral rhinosinusitis (AVRS) by evidence of one of the following: Symptoms that persist >10 days without improvement has probability of bacterial rhinosinusitis of 60% […] If Acute Viral Rhinosinusitis offer supportive care […] Most patients improve with symptomatic treatment alone: Analgesics | Antipyretics | Nasal saline irrigation | Intranasal glucocorticoids […] If Acute Bacterial Rhinosinusitis offer antibiotic therapy or period of ‘watchful waiting’ in conjunction with supportive care […] Watchful waiting: Observation period (without antibiotics) for 7 days from time of diagnosis of ARBS […] When to initiate antibiotics: If symptoms worsen during “watchful waiting” initiate antibiotic therapy

• #47 Sinus Infection Basics | Sinus Infection | CDC

  https://www.cdc.gov/sinus-infection/about/index.html

  You do not need antibiotics for many sinus infections. Most sinus infections usually get better on their own without antibiotics. […] However, in some cases, you may need antibiotics. Talk to your healthcare provider about the best treatment for your illness. […] For some sinus infections, your healthcare provider might recommend watchful waiting or delayed antibiotic prescribing. […] Your healthcare provider may suggest watching and waiting for 2-3 days to see if you need antibiotics. This gives the immune system time to fight off the infection. If your symptoms don’t improve, the healthcare provider may prescribe an antibiotic. […] Your healthcare provider may prescribe an antibiotic but suggest that you wait 2-3 days before filling the prescription. You may recover on your own and may not need the antibiotic.

• #48 Sinusitis: From Diagnosis to Treatment – The ObG Project

  https://www.obgproject.com/2023/01/17/sinusitis-from-diagnosis-to-treatment/

  Typical duration of treatment is 5 to 10 days […] First line antibiotic: Amoxicillin with or without clavulanate (500mg/125mg TID or 875mg/125mg BID) […] If high risk of bacterial resistance or poor outcome: Use high dose Augmentin 2g ER BID (amoxicillin 2g with clavulanate BID) […] If Penicillin allergy: Doxycycline | Clindamycin plus third generation cephalosporin | Respiratory fluoroquinolone […] Treatment failure occurs when symptoms worsen or fail to improve within 7 days of antibiotic therapy […] Consider referral to otolaryngologist or allergist in the following cases: Development of complications […] Patients who are seriously ill and immunocompromised […] Refractory cases […] Recurrent cases.

• #49 Re-Thinking Acute Sinusitis Treatment in Adults: What Works and What Doesn’t – Clinical Advisor

  https://www.clinicaladvisor.com/features/re-thinking-acute-sinusitis-treatment-in-adults-what-works-and-what-doesnt/

  Because antibiotic overprescribing is a widespread problem in treating acute sinusitis, clinicians must rethink their treatment protocols when a patient presents with this condition. […] Sinusitis will often resolve in most patients without antibiotic treatment, even if it is bacterial in origin. […] The current over-prescribing of antibiotics has led to a substantial increase in drug-resistant pathogens an urgent public health threat in the US. This has led to increased mortality, morbidity, and cost. […] Increasing bacterial resistance, coupled with the decrease in development of new antibiotics, signals a need for better alternative interventions to treat the symptoms of patients presenting to ambulatory care settings with sinus symptoms.

• #50 Acute sinusitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/acute-sinusitis/diagnosis-treatment/drc-20351677

  Most cases of acute sinusitis get better on their own. Self-care is usually all that’s needed to ease symptoms. […] The following might help ease sinusitis symptoms: […] Saline nasal spray. Salt water sprayed into the nose many times a day rinses the inside of the nose. […] Nasal corticosteroids. These nasal sprays help prevent and treat swelling. […] Decongestants. These medicines are available with and without a prescription. […] Allergy medicines. For sinusitis caused by allergies, using allergy medicines might lessen allergy symptoms. […] Pain relievers. Try acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or aspirin available without a prescription. […] Antibiotics don’t treat viruses, which are the usual cause of acute sinusitis. […] But, if you have severe, worsening or long-lasting symptoms, your symptoms might need to be treated with antibiotics. […] For sinusitis caused or made worse by allergies, allergy shots might help. This is known as immunotherapy. […] No alternative therapies have been proved to ease the symptoms of acute sinusitis.

• #51 Sinus Infection (Sinusitis): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17701-sinusitis

  Acute sinusitis symptoms (nasal congestion, drainage, facial pain/pressure and decreased sense of smell) last less than four weeks. It’s usually caused by viruses like the common cold. […] If symptoms of sinusitis don’t improve after 10 days, a provider may prescribe: Antibiotics. Oral or topical decongestants. Prescription intranasal steroid sprays. […] Providers treat chronic sinusitis by focusing on the underlying condition. Treatments can include: Intranasal steroid sprays. Topical antihistamine sprays or oral pills. Leukotriene antagonists, like montelukast. Surgery to treat structural issues, polyps or fungal infections. […] You might find acupressure, acupuncture or facial massage helpful in reducing symptoms of sinusitis, including draining, pressure and pain. Ask a provider if these therapies might help in your specific case.

• #52 Sinusitis – acute | Healthify

  https://healthify.nz/health-a-z/s/sinusitis-acute

  Pain relief medication: take pain relief medicines (eg, paracetamol), or non-steroidal anti-inflammatories (NSAIDs, eg, ibuprofen) to reduce pain and discomfort. […] Antihistamines can help to dry up nasal secretions and relieve a post-nasal drip if your symptoms are caused by hay fever or an allergy. […] Decongestant nasal sprays or drops (eg, oxymetazoline) can help to reduce congestion and swelling within your nose and sinuses. […] Steroid nasal sprays: your healthcare provider may recommend the use of steroid nasal sprays (eg, Flixonase) to relieve your symptoms. […] Antibiotics are seldom needed to treat sinusitis because sinusitis is mostly caused by viruses (a viral infection). […] Antibiotics are considered when symptoms last longer than 10 days, start to improve but then worsen again, or are very severe. […] If you are given antibiotics, finish the full course. […] Many people recover from sinusitis caused by colds in about a week, but symptoms can take anywhere from 10 days up to 8 weeks to clear up.

• #53 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Treatment-of-sinusitis.aspx

  The nasal passages may be irrigated with normal saline. This is called nasal saline irrigation. […] These are usually needed in patients who have a bacterial or fungal infection of the sinuses. Antibiotics may also be needed in patients with viral infections and inflammations in case there are secondary bacterial infections. […] In case of bacterial sinusitis, 70% of patients improve within 2 weeks without antibiotics and around 85% improve with necessary antibiotics. Azithromycin is one of the antibiotics that are approved for use in acute bacterial sinusitis. […] If allergies are the cause of the recurrent sinusitis, anti-allergy medications like antihistamines may be prescribed. […] Patients with severe inflammation of the nasal and sinus mucosal membranes may need prescription nasal sprays with corticosteroids like Fluticasone, Betamethasone or Beclomethasone.

• #54 What Is the Treatment of Choice for Acute Sinusitis? – Socal Sinus

  https://www.socalsinus.com/what-is-the-treatment-of-choice-for-acute-sinusitis/

  Acute sinusitis treatments fall into several categories: […] Symptomatic Relief: Nasal decongestants and saline irrigation help alleviate congestion. Pain relievers, such as acetaminophen or ibuprofen, can address discomfort. […] Antibiotics for Bacterial Sinusitis: Amoxicillin is often the first-line antibiotic for uncomplicated bacterial sinusitis. Other options may be considered based on individual factors. The typical course of antibiotics for bacterial sinusitis is 5-10 days. Completing the full course is essential to prevent antibiotic resistance. […] Nasal Corticosteroids: These anti-inflammatory sprays reduce sinus inflammation and congestion. They are particularly beneficial in cases of allergic or chronic sinusitis. […] Immunotherapy: Allergen immunotherapy is prescribed to desensitize the immune systems reaction to triggering allergens and alleviate symptoms.

• #55 Sinus Infection (Sinusitis): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17701-sinusitis

  Acute sinusitis symptoms (nasal congestion, drainage, facial pain/pressure and decreased sense of smell) last less than four weeks. It’s usually caused by viruses like the common cold. […] If symptoms of sinusitis don’t improve after 10 days, a provider may prescribe: Antibiotics. Oral or topical decongestants. Prescription intranasal steroid sprays. […] Providers treat chronic sinusitis by focusing on the underlying condition. Treatments can include: Intranasal steroid sprays. Topical antihistamine sprays or oral pills. Leukotriene antagonists, like montelukast. Surgery to treat structural issues, polyps or fungal infections. […] You might find acupressure, acupuncture or facial massage helpful in reducing symptoms of sinusitis, including draining, pressure and pain. Ask a provider if these therapies might help in your specific case.

• #56 Acute Sinusitis Treatment & Management: Approach Considerations, Symptomatic Treatment, Antimicrobial Therapy

  https://emedicine.medscape.com/article/232670-treatment

  The primary goals of management of acute sinusitis are to eradicate the infection, decrease the severity and duration of symptoms, and prevent complications. […] These goals are achieved through the provision of adequate drainage and appropriate systemic treatment of the likely bacterial pathogens. […] Sinus puncture and irrigation techniques allow for a surgical means of removal of thick purulent sinus secretions. […] A surgical means of sinus drainage should be used when appropriate medical therapy has failed to control the infection and prolonged or slowly resolving symptoms result or when complications of sinusitis occur. […] Most patients with acute sinusitis are treated in the primary care setting. […] While in the emergency department and upon discharge, patients may obtain significant immediate relief with the administration of first-generation antihistamines, decongestants, and nonsteroidal anti-inflammatory drugs (NSAIDs).

• #57 Acute Sinusitis Treatment & Management: Approach Considerations, Symptomatic Treatment, Antimicrobial Therapy

  https://emedicine.medscape.com/article/232670-treatment

  Surgical treatment for acute frontal sinusitis is undertaken when the infection fails to respond to conservative therapy or when dangerous complications arise. […] Surgical treatment can reduce the inflammation and edema of the mucosa, alleviate the pain, combat the infection, open the ostia of the sinuses, and restore normal mucociliary secretions.

• #58 Acute Sinusitis Treatment & Management: Approach Considerations, Symptomatic Treatment, Antimicrobial Therapy

  https://emedicine.medscape.com/article/232670-treatment

  The primary goals of management of acute sinusitis are to eradicate the infection, decrease the severity and duration of symptoms, and prevent complications. […] These goals are achieved through the provision of adequate drainage and appropriate systemic treatment of the likely bacterial pathogens. […] Sinus puncture and irrigation techniques allow for a surgical means of removal of thick purulent sinus secretions. […] A surgical means of sinus drainage should be used when appropriate medical therapy has failed to control the infection and prolonged or slowly resolving symptoms result or when complications of sinusitis occur. […] Most patients with acute sinusitis are treated in the primary care setting. […] While in the emergency department and upon discharge, patients may obtain significant immediate relief with the administration of first-generation antihistamines, decongestants, and nonsteroidal anti-inflammatory drugs (NSAIDs).

• #59 Treating acute sinusitis – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/treating-acute-sinusitis-3.html

  Should the patient fail to respond to this regimen, second line therapy should be selected from an amoxycillin-clavulanate combination, cefaclor, cefuroxime axetil, loracarbef or cefixime. […] Most cases of acute sinusitis can be managed by the general practitioner. However, referral should occur if complications develop or if the patient fails to respond to second-line therapy. […] The specialist will perform nasal endoscopy with a rigid nasal telescope to confirm the presence of pus in the middle meatus and/or spheno-ethmoidal recess.

• #60 Complicated Acute Sinusitis — Headmirror

  https://www.headmirror.com/complicated-acute-sinusitis

  While most cases of acute sinusitis resolve spontaneously or with medical therapy, consults to evaluate potential complications of sinusitis are common. Acute sinusitis typically develops from a viral or bacterial infection of the paranasal sinuses leading to inflammation, edema, and ultimately obstruction of the sinus outflow tracts. Acute sinusitis is typically managed medically with topical and sometimes systemic medications. This guide will focus on the management of the complications of untreated or progressive acute sinusitis. For this guide, the complications of sinusitis are distilled into orbital and intracranial complications. […] Surgery is indicated for patients in most cases of Chandler Group III-V, but also may be considered for Chandler Groups I-II. While a trial of intravenous antibiotics is appropriate in many cases, surgical treatment should not be delayed in the case of a defined orbital abscess, ophthalmoplegia, or vision loss. An ophthalmology consultation serves as a great resource for management of these orbital complications.

• #61 Acute Sinusitis Treatment & Management: Approach Considerations, Symptomatic Treatment, Antimicrobial Therapy

  https://emedicine.medscape.com/article/232670-treatment

  Surgical treatment for acute frontal sinusitis is undertaken when the infection fails to respond to conservative therapy or when dangerous complications arise. […] Surgical treatment can reduce the inflammation and edema of the mucosa, alleviate the pain, combat the infection, open the ostia of the sinuses, and restore normal mucociliary secretions.

• #62 Medical Management of Sinusitis | Iowa Head and Neck Protocols

  https://medicine.uiowa.edu/iowaprotocols/medical-management-sinusitis

  In addition to treatment of acute episodes of sinusitis, a search is made for predisposing factors. A combination of nasal endoscopy and CT scans may demonstrate anatomical predisposing factors, such as nasal polyps, septal deviation, concha bullosa, or infraorbital ethmoid cells (Haller cells). Allergy evaluation may be of benefit to some patients. […] Antibiotic selection in cases of chronic sinusitis will depend upon previous antibiotics used and previous duration of treatment. In patients who have had little by way of previous treatment, amoxicillin is employed for three weeks in doses of 500 mg TID in patients not allergic to penicillin. […] Patients with chronic sinusitis usually benefit from a steroid nasal spray. Many will also benefit from nasal saline irrigations. The „recipe” for the irrigations and patient instructions are listed in Nursing Protocols (Home Care Instructions, Nasal Irrigation).

• #63 Complicated Acute Sinusitis — Headmirror

  https://www.headmirror.com/complicated-acute-sinusitis

  While most cases of acute sinusitis resolve spontaneously or with medical therapy, consults to evaluate potential complications of sinusitis are common. Acute sinusitis typically develops from a viral or bacterial infection of the paranasal sinuses leading to inflammation, edema, and ultimately obstruction of the sinus outflow tracts. Acute sinusitis is typically managed medically with topical and sometimes systemic medications. This guide will focus on the management of the complications of untreated or progressive acute sinusitis. For this guide, the complications of sinusitis are distilled into orbital and intracranial complications. […] Surgery is indicated for patients in most cases of Chandler Group III-V, but also may be considered for Chandler Groups I-II. While a trial of intravenous antibiotics is appropriate in many cases, surgical treatment should not be delayed in the case of a defined orbital abscess, ophthalmoplegia, or vision loss. An ophthalmology consultation serves as a great resource for management of these orbital complications.

• #64 Complicated Acute Sinusitis — Headmirror

  https://www.headmirror.com/complicated-acute-sinusitis

  Disease is typically responsive to medical management, however, sinus surgery may play a role in refractory disease. If surgery is required, it typically consists of endoscopic sinus surgery (ESS) of affected sinuses in proximity to the lamina papyracea, most notably a maxillary antrostomy and total ethmoidectomy. […] Surgery is indicated in almost all cases and involves ESS with or without craniotomy dependent on intracranial disease extent. Goal of surgery is infection source control and culture collection.

• #65 Acute Sinusitis Management

  https://mobile.fpnotebook.com/ENT/Sinus/ActSnstsMngmnt.htm

  Macrolide Antibiotics (Erythromycin, Azithromycin, Clarithromycin) […] Trimethoprim-Sulfamethoxazole (Bactrim, Septra) […] Sinusitis refractory to maximal medical management […] Recurrent Acute Sinusitis (3-4 episodes per year) […] Persistent Chronic Sinusitis Symptoms […] Complicated Sinusitis (emergent and urgent Consultations) […] Immunocompromised patient […] Toxic appearance or severe infection with high fever (e.g. 102 F or 39 C) […] Osteomeatal obstruction or sinus obstruction due to anatomic defects […] Fungal Sinusitis […] Nosocomial Infection or other atypical Bacteria […] Suspected contiguous orbital or cerebral involvement […] Periorbital swelling or Diplopia […] Sphenoid and Frontal Sinusitis are higher risk […] Orbital Cellulitis or intraorbital abscess […] Subperiosteal abscess […] Cavernous Sinus Thrombosis […] Intracranial Abscess […] Frontal bone Osteomyelitis (Pott Puffy Tumor)

• #66 Complicated Acute Sinusitis — Headmirror

  https://www.headmirror.com/complicated-acute-sinusitis

  While most cases of acute sinusitis resolve spontaneously or with medical therapy, consults to evaluate potential complications of sinusitis are common. Acute sinusitis typically develops from a viral or bacterial infection of the paranasal sinuses leading to inflammation, edema, and ultimately obstruction of the sinus outflow tracts. Acute sinusitis is typically managed medically with topical and sometimes systemic medications. This guide will focus on the management of the complications of untreated or progressive acute sinusitis. For this guide, the complications of sinusitis are distilled into orbital and intracranial complications. […] Surgery is indicated for patients in most cases of Chandler Group III-V, but also may be considered for Chandler Groups I-II. While a trial of intravenous antibiotics is appropriate in many cases, surgical treatment should not be delayed in the case of a defined orbital abscess, ophthalmoplegia, or vision loss. An ophthalmology consultation serves as a great resource for management of these orbital complications.

• #67 Complicated Acute Sinusitis — Headmirror

  https://www.headmirror.com/complicated-acute-sinusitis

  Disease is typically responsive to medical management, however, sinus surgery may play a role in refractory disease. If surgery is required, it typically consists of endoscopic sinus surgery (ESS) of affected sinuses in proximity to the lamina papyracea, most notably a maxillary antrostomy and total ethmoidectomy. […] Surgery is indicated in almost all cases and involves ESS with or without craniotomy dependent on intracranial disease extent. Goal of surgery is infection source control and culture collection.

• #68 Acute Sinusitis Management

  https://mobile.fpnotebook.com/ENT/Sinus/ActSnstsMngmnt.htm

  Macrolide Antibiotics (Erythromycin, Azithromycin, Clarithromycin) […] Trimethoprim-Sulfamethoxazole (Bactrim, Septra) […] Sinusitis refractory to maximal medical management […] Recurrent Acute Sinusitis (3-4 episodes per year) […] Persistent Chronic Sinusitis Symptoms […] Complicated Sinusitis (emergent and urgent Consultations) […] Immunocompromised patient […] Toxic appearance or severe infection with high fever (e.g. 102 F or 39 C) […] Osteomeatal obstruction or sinus obstruction due to anatomic defects […] Fungal Sinusitis […] Nosocomial Infection or other atypical Bacteria […] Suspected contiguous orbital or cerebral involvement […] Periorbital swelling or Diplopia […] Sphenoid and Frontal Sinusitis are higher risk […] Orbital Cellulitis or intraorbital abscess […] Subperiosteal abscess […] Cavernous Sinus Thrombosis […] Intracranial Abscess […] Frontal bone Osteomyelitis (Pott Puffy Tumor)

• #69 Acute sinusitis – Symptoms, Causes, Diagnosis and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/acute-sinusitis

  Since viral infection causes most cases of acute sinusitis, which usually resolves without specific treatment, antibiotics are not required. Your doctor may consider giving you antibiotics if you have a severe, long-lasting course of sinusitis. You should complete the course of antibiotics even if you feel better. An incomplete course of antibiotics can allow your symptoms to recur. […] The following self-care tips can help treat your symptoms: […] Taking a rest can speed up your recovery and help fight infection. […] Drink plenty of water. […] Apply a warm pack to your nose to relieve pressure in the nasal cavities. […] Moisten your nasal passage by inhaling water vapors. Position your head, covered in a towel, over a bowl of hot water, or take a hot shower, and breathing in the water vapors can help drain nasal discharge with symptom relief. […] Rinse your nose with nasal saline irrigation or a nasal wash squeeze bottle to clear your nasal passages.

• #70 Acute vs Chronic Sinusitis: Treatment Options

  https://www.houstonent.com/blog/acute-vs-chronic-sinusitis-treatment-options

  If your sinusitis symptoms last for less than 4 weeks, it’s acute. It usually starts with a cold with symptoms disappearing between a week to 10 days. In some cases, a bacterial infection can develop. […] Start off with self-help remedies (under your doctors advice) to see if they help ease your symptoms followed by prescribed treatment by your doctor if they don’t. Chronic sinusitis typically takes longer to treat than acute sinusitis and requires you to be seen and treated by a physician. […] With this type of sinusitis, self-care techniques tend to be all you need. These include: Rest. Get plenty of rest so your body can fight off the infection and you can recover faster. […] If self-care methods aren’t working, your doctor may advise you to use other types of treatments that can help, including: Saline Nasal Spray: Spray the saline into your nose daily (3 times) to clear your nasal passages.

• #71 Acute sinusitis – Symptoms, Causes, Diagnosis and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/acute-sinusitis

  Since viral infection causes most cases of acute sinusitis, which usually resolves without specific treatment, antibiotics are not required. Your doctor may consider giving you antibiotics if you have a severe, long-lasting course of sinusitis. You should complete the course of antibiotics even if you feel better. An incomplete course of antibiotics can allow your symptoms to recur. […] The following self-care tips can help treat your symptoms: […] Taking a rest can speed up your recovery and help fight infection. […] Drink plenty of water. […] Apply a warm pack to your nose to relieve pressure in the nasal cavities. […] Moisten your nasal passage by inhaling water vapors. Position your head, covered in a towel, over a bowl of hot water, or take a hot shower, and breathing in the water vapors can help drain nasal discharge with symptom relief. […] Rinse your nose with nasal saline irrigation or a nasal wash squeeze bottle to clear your nasal passages.

• #72 Acute sinusitis – Symptoms, Causes, Diagnosis and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/acute-sinusitis

  Since viral infection causes most cases of acute sinusitis, which usually resolves without specific treatment, antibiotics are not required. Your doctor may consider giving you antibiotics if you have a severe, long-lasting course of sinusitis. You should complete the course of antibiotics even if you feel better. An incomplete course of antibiotics can allow your symptoms to recur. […] The following self-care tips can help treat your symptoms: […] Taking a rest can speed up your recovery and help fight infection. […] Drink plenty of water. […] Apply a warm pack to your nose to relieve pressure in the nasal cavities. […] Moisten your nasal passage by inhaling water vapors. Position your head, covered in a towel, over a bowl of hot water, or take a hot shower, and breathing in the water vapors can help drain nasal discharge with symptom relief. […] Rinse your nose with nasal saline irrigation or a nasal wash squeeze bottle to clear your nasal passages.

• #73 Acute Sinusitis: Symptoms and Treatment

  https://patient.info/ears-nose-throat-mouth/acute-sinusitis

  Acute sinusitis is a sinus infection which usually goes away on its own without treatment. There are various treatments that may help to ease symptoms. Antibiotic medicines are only needed sometimes. […] Acute sinusitis often clears up without treatment. However, there are several things you can do to treat the symptoms in the meantime. […] If your symptoms persist for more than 10 days your doctor may consider prescribing a high-dose steroid nose spray such as mometasone. […] Not usually. Department of Health guidelines recommend that antibiotics should not be used for at least the first 10 days. […] They may be considered if you become very unwell or if your symptoms persist for more than 10 days and don’t respond to other measures. […] Some treatments may help to relieve symptoms whilst you are waiting for your immune system to clear the infection. These include the following: Painkillers such as paracetamol or ibuprofen will usually ease any pain. […] Decongestant nasal sprays or drops are sometimes used. […] Keeping hydrated can be helpful, so have plenty of drinks. […] Warm face packs held over the sinuses may help to ease pain. […] Saline nasal washing may help to relieve congestion and blockage in the nose.

• #74 Acute sinusitis – Symptoms, Causes, Diagnosis and Treatment | MedPark Hospital

  https://www.medparkhospital.com/en-US/disease-and-treatment/acute-sinusitis

  Since viral infection causes most cases of acute sinusitis, which usually resolves without specific treatment, antibiotics are not required. Your doctor may consider giving you antibiotics if you have a severe, long-lasting course of sinusitis. You should complete the course of antibiotics even if you feel better. An incomplete course of antibiotics can allow your symptoms to recur. […] The following self-care tips can help treat your symptoms: […] Taking a rest can speed up your recovery and help fight infection. […] Drink plenty of water. […] Apply a warm pack to your nose to relieve pressure in the nasal cavities. […] Moisten your nasal passage by inhaling water vapors. Position your head, covered in a towel, over a bowl of hot water, or take a hot shower, and breathing in the water vapors can help drain nasal discharge with symptom relief. […] Rinse your nose with nasal saline irrigation or a nasal wash squeeze bottle to clear your nasal passages.

• #75 What Is the Treatment of Choice for Acute Sinusitis? – Socal Sinus

  https://www.socalsinus.com/what-is-the-treatment-of-choice-for-acute-sinusitis/

  Steam Inhalation: Inhaling steam can provide relief by moisturizing nasal passages and promoting drainage. Adding essential oils like eucalyptus may enhance the soothing effect. […] Avoiding Triggers: Steering clear of irritants like cigarette smoke and addressing underlying allergies aids recovery. Adequate hydration supports mucus clearance. […] Persistent or recurrent cases may require more extensive evaluation and advanced treatment. A consultation with an ENT/sinus specialist is necessary. […] In-Office Endoscopic Sinus Surgery is a minimally invasive procedure that utilizes an endoscope to navigate and treat sinus issues, eliminating the need for a hospital setting. […] Functional Endoscopic Sinus Surgery (FESS) is another minimally invasive procedure that employs a thin, flexible endoscope to navigate and precisely remove obstructive sinus tissues, promoting improved drainage and airflow.

• #76 Acute Recurrent Sinusitis: Symptoms, Causes and Treatment – Houston Advanced Sinus

  https://houstonadvancedsinus.com/acute-recurrent-sinusitis-symptoms-causes-and-treatment/

  Doctors usually start with an aggressive medical treatment to control the problem and move to mild ones over the time. The course of treatment includes: […] Patients with environmental allergies should avoid getting in contact with the allergens to avoid allergic rhinitis. Patients need to quit smoking, as it contributes to recurrent sinusitis. […] Washing nasal passages with large volume salt water (240mL) reduces symptoms. In addition to this, patients need to wash their nose before applying medicine to clear the mucus. […] Recurrent sinusitis has some degree of inflammation, and the patient needs medication to reduce the irritation and swelling. The nasal steroids will reduce the impact of allergic rhinitis in triggering recurrent acute sinusitis. […] Oral antibiotics are often used to treat the episodes of recurrent acute sinusitis. Treatment can be anywhere from 7 to 21 days on broad spectrum oral antibiotics depending on the severity of the infection and patient response to the treatment.

• #77 How to Get Rid of a Sinus Infection: Home Remedies and Medication

  https://www.healthline.com/health/how-to-get-rid-of-sinus-infection

  Home remedies may help manage the symptoms of a sinus infection. Many sinus infections improve independently, but some bacterial cases may require antibiotics. […] However, bacterial sinus infections can improve with a course of antibiotic treatment. You should start feeling better within 3-4 days. […] Doctors may prescribe antibiotics in cases of chronic sinusitis or if your sinus infection is bacterial. Your primary care provider will determine whether bacteria or a virus causes your sinus infection. […] Amoxicillin (Amoxil) is a common prescription drug for acute sinus infections. Amoxicillin-clavulanate (Augmentin) is often prescribed for a bacterial sinus infection. […] Depending on the type of antibiotic, a person may need to take them for up to three weeks. It’s important to take antibiotics as long as your doctor prescribes them. Don’t stop taking them early, even if your symptoms improve as this can result in antibiotic resistance.

• #78 Acute Bacterial Rhinosinusitis | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/a/acute-bacterial-rhinosinusitis-1.html

  Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is. […] Treatments for ABRS can include: […] Antibiotics to kill the infecting bacteria. […] Your health care provider will tell you which treatments will work best for you. […] Your provider may not give you antibiotics at first. It is hard to tell if you have a bacterial infection. So other treatments may be advised. Antibiotics dont help rhinosinusitis caused by a virus. health care providers dont like to give antibiotics if theyre not needed. People with ABRS may get better even without antibiotics. […] If your symptoms dont get better in several days, you might need antibiotics. If your provider finds that you have a bacterial infection at your first visit, you might get antibiotics right away.

• #79 Acute sinusitis: Do over-the-counter treatments help?

  https://www.mayoclinic.org/diseases-conditions/acute-sinusitis/expert-answers/acute-sinusitis/faq-20058562

  Yes. Pain relievers and decongestants that you can get without a prescription may help ease acute sinusitis symptoms. They may ease pain around the face and sinus congestion. […] Medicines you can get without a prescription that may help include: […] Decongestants. These work by narrowing blood vessels to help lessen swelling that causes sinus congestion. Such medicines available without a prescription (Sudafed, others) are sold as liquids, tablets and nasal sprays. […] Pain relievers. Pain caused by pressure buildup in the sinus cavities may be eased by pain relievers. Examples include acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others). […] Most people with acute sinusitis get better without antibiotics. But if your symptoms are severe or last longer than a few days, talk to your healthcare professional.

• #80 Acute Rhinosinusitis in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0501/p1057.html

  Rhinosinusitis is one of the most common conditions for which patients seek medical care. […] Symptomatic treatment with analgesics, decongestants, and saline nasal irrigation is appropriate in patients who present with nonsevere symptoms (e.g., mild pain, temperature less than 101F [38.3C]). Narrow-spectrum antibiotics, such as amoxicillin or trimethoprim/sulfamethoxazole, are recommended in patients with symptoms or signs of acute rhinosinusitis that do not improve after seven days, or that worsen at any time. […] Limited evidence supports the use of intranasal corticosteroids in patients with acute rhinosinusitis. […] Antibiotic therapy is recommended for patients with rhinosinusitis symptoms that do not improve within seven days or that worsen at any time; those with moderate illness (moderate to severe pain or temperature 101F [38.3C]); or those who are immunocompromised.

• #81 Acute Sinusitis Management

  https://mobile.fpnotebook.com/ENT/Sinus/ActSnstsMngmnt.htm

  Premature Antibiotic use (and Antibiotic Overuse) in Acute Sinusitis is common and unwarranted […] Up to 70% of Acute Sinusitis 14 days resolves without Antibiotics […] Number Needed to Treat (NNT) for Antibiotic in Acute Sinusitis benefit: 11-15 […] Number needed to harm (NNH) for Antibiotic in Acute Sinusitis adverse effects: 8 […] Indicated only in acute Bacterial Sinusitis […] Only 10% of Sinusitis cases overall are Bacterial […] Persistent Sinusitis symptoms 10 days (Bacterial in 60% of cases) […] IDSA uses 7 days of persistent symptoms as a treatment indication […] Moderate to severe unilateral facial pain for at least 3-4 days […] May be associated with Maxillary Toothache […] Persistent Fever over 101 to 102 F […] Upper respiratory symptoms for 5 to 6 days that resolved and then recurred (double-Hump Sign)

• #82 Acute Sinusitis Management

  https://mobile.fpnotebook.com/ENT/Sinus/ActSnstsMngmnt.htm

  Premature Antibiotic use (and Antibiotic Overuse) in Acute Sinusitis is common and unwarranted […] Up to 70% of Acute Sinusitis 14 days resolves without Antibiotics […] Number Needed to Treat (NNT) for Antibiotic in Acute Sinusitis benefit: 11-15 […] Number needed to harm (NNH) for Antibiotic in Acute Sinusitis adverse effects: 8 […] Indicated only in acute Bacterial Sinusitis […] Only 10% of Sinusitis cases overall are Bacterial […] Persistent Sinusitis symptoms 10 days (Bacterial in 60% of cases) […] IDSA uses 7 days of persistent symptoms as a treatment indication […] Moderate to severe unilateral facial pain for at least 3-4 days […] May be associated with Maxillary Toothache […] Persistent Fever over 101 to 102 F […] Upper respiratory symptoms for 5 to 6 days that resolved and then recurred (double-Hump Sign)

• #83 Acute Sinusitis Management

  https://mobile.fpnotebook.com/ENT/Sinus/ActSnstsMngmnt.htm

  Macrolide Antibiotics (Erythromycin, Azithromycin, Clarithromycin) […] Trimethoprim-Sulfamethoxazole (Bactrim, Septra) […] Sinusitis refractory to maximal medical management […] Recurrent Acute Sinusitis (3-4 episodes per year) […] Persistent Chronic Sinusitis Symptoms […] Complicated Sinusitis (emergent and urgent Consultations) […] Immunocompromised patient […] Toxic appearance or severe infection with high fever (e.g. 102 F or 39 C) […] Osteomeatal obstruction or sinus obstruction due to anatomic defects […] Fungal Sinusitis […] Nosocomial Infection or other atypical Bacteria […] Suspected contiguous orbital or cerebral involvement […] Periorbital swelling or Diplopia […] Sphenoid and Frontal Sinusitis are higher risk […] Orbital Cellulitis or intraorbital abscess […] Subperiosteal abscess […] Cavernous Sinus Thrombosis […] Intracranial Abscess […] Frontal bone Osteomyelitis (Pott Puffy Tumor)

• #84 Acute Sinusitis Management

  https://mobile.fpnotebook.com/ENT/Sinus/ActSnstsMngmnt.htm

  Macrolide Antibiotics (Erythromycin, Azithromycin, Clarithromycin) […] Trimethoprim-Sulfamethoxazole (Bactrim, Septra) […] Sinusitis refractory to maximal medical management […] Recurrent Acute Sinusitis (3-4 episodes per year) […] Persistent Chronic Sinusitis Symptoms […] Complicated Sinusitis (emergent and urgent Consultations) […] Immunocompromised patient […] Toxic appearance or severe infection with high fever (e.g. 102 F or 39 C) […] Osteomeatal obstruction or sinus obstruction due to anatomic defects […] Fungal Sinusitis […] Nosocomial Infection or other atypical Bacteria […] Suspected contiguous orbital or cerebral involvement […] Periorbital swelling or Diplopia […] Sphenoid and Frontal Sinusitis are higher risk […] Orbital Cellulitis or intraorbital abscess […] Subperiosteal abscess […] Cavernous Sinus Thrombosis […] Intracranial Abscess […] Frontal bone Osteomyelitis (Pott Puffy Tumor)

• #85 Acute Sinusitis Management

  https://mobile.fpnotebook.com/ENT/Sinus/ActSnstsMngmnt.htm

  Premature Antibiotic use (and Antibiotic Overuse) in Acute Sinusitis is common and unwarranted […] Up to 70% of Acute Sinusitis 14 days resolves without Antibiotics […] Number Needed to Treat (NNT) for Antibiotic in Acute Sinusitis benefit: 11-15 […] Number needed to harm (NNH) for Antibiotic in Acute Sinusitis adverse effects: 8 […] Indicated only in acute Bacterial Sinusitis […] Only 10% of Sinusitis cases overall are Bacterial […] Persistent Sinusitis symptoms 10 days (Bacterial in 60% of cases) […] IDSA uses 7 days of persistent symptoms as a treatment indication […] Moderate to severe unilateral facial pain for at least 3-4 days […] May be associated with Maxillary Toothache […] Persistent Fever over 101 to 102 F […] Upper respiratory symptoms for 5 to 6 days that resolved and then recurred (double-Hump Sign)

• #86 Acute Sinusitis (Adults)

  https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/upper-respiratory/acute-sinusitis/

  GPs can use the Respiratory infection information leaflet (including self-care and safety-netting advice) during consultations with patients presenting with acute sinusitis where there is no immediate need for an antibiotic. […] Consider the use of high dose intranasal steroids in people presenting with symptoms for around 10 days or more. […] Bacterial sinusitis is usually self-limiting and does not routinely need antibiotics. 80% of cases resolve in 14 days without antibiotics and offer only marginal benefit after day 7. […] Advise self-care for all patients. […] Consider a no antibiotic strategy for patients with symptoms less than 10 days unless systemically very unwell. […] Consider a no antibiotic or delayed antibiotic prescription in people presenting with symptoms for around 10 days or more without clinical improvement.

• #87 Acute Sinusitis (Adults)

  https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/upper-respiratory/acute-sinusitis/

  Offer an immediate antibiotic prescription for patients systemically very unwell, with immunosuppression, or signs of severe infection or high risk of complications. […] For adults who have symptoms 10 days consider topical intranasal corticosteroid. […] Examples of intranasal corticosteroids that have been shown in studies to improve symptoms of acute sinusitis include: Fluticasone Furoate 27.5 microgram/dose nasal spray, Two sprays per nostril every 24 hours, 14 days. […] Consider no antibiotic strategy if symptoms 10 days. […] Consider a no or delayed antibiotic strategy if symptoms 10 days if not systemically very unwell, no signs of severe infection or not at high risk of complications. […] Offer immediate antibiotic prescription if systemically very unwell, signs of severe infection or high risk of complications. […] The general recommendation is for 5 days initial antibiotic treatment. However, a total of 7 to 10 day course of antibiotics may be considered in select cases.

• #88 Re-Thinking Acute Sinusitis Treatment in Adults: What Works and What Doesn’t – Clinical Advisor

  https://www.clinicaladvisor.com/features/re-thinking-acute-sinusitis-treatment-in-adults-what-works-and-what-doesnt/

  Because antibiotic overprescribing is a widespread problem in treating acute sinusitis, clinicians must rethink their treatment protocols when a patient presents with this condition. […] Sinusitis will often resolve in most patients without antibiotic treatment, even if it is bacterial in origin. […] The current over-prescribing of antibiotics has led to a substantial increase in drug-resistant pathogens an urgent public health threat in the US. This has led to increased mortality, morbidity, and cost. […] Increasing bacterial resistance, coupled with the decrease in development of new antibiotics, signals a need for better alternative interventions to treat the symptoms of patients presenting to ambulatory care settings with sinus symptoms.

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