![]() Adverse effects occurred more often with antibiotic use than with placebo (number needed to harm = 9). At 14 to 15 days, antibiotic therapy was no longer beneficial. ![]() Antibiotic use increased the absolute cure rate by 15 percent compared with placebo at seven to 12 days (number needed to treat = 7). 11 Complete clinical cure without antibiotics occurred in 8 percent of patients within three to five days, in 35 percent within seven to 12 days, and in 45 percent within 14 to 15 days. 1 In a systematic review of 13 randomized trials of antibiotic use in adults with acute rhinosinusitis, more than 70 percent clinically improved after seven days, with or without antibiotic therapy. Mild rhinosinusitis symptoms of less than seven days' duration can be managed with supportive care, including analgesics, short-term decongestants, saline nasal irrigation, and intranasal corticosteroids.Īntibiotics may be considered in patients with symptoms or signs of acute rhinosinusitis that do not improve within seven days or that worsen at any time in those with moderate to severe pain or a temperature of 101☏ (38.3☌) or higher and in those who are immunocompromised. Trimethoprim/sulfamethoxazole (Bactrim, Septra) and macrolide antibiotics are reasonable alternatives to amoxicillin for treating acute bacterial rhinosinusitis in patients who are allergic to penicillin. Radiographic imaging in patients with acute rhinosinusitis is not recommended unless a complication or an alternative diagnosis is suspected.Īntibiotic 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 ≥ 101☏ ) or those who are immunocompromised.Īmoxicillin is considered the first-line antibiotic for most patients with acute bacterial rhinosinusitis. If symptoms persist or progress after maximal medical therapy, and if computed tomography shows evidence of sinus disease, referral to an otolaryngologist is warranted. Rare complications of acute bacterial rhinosinusitis include orbital, intracranial, and bony involvement. Computed tomography of the sinuses should not be used for routine evaluation, although it may be used to define anatomic abnormalities and evaluate patients with suspected complications of acute bacterial rhinosinusitis. Radiographic imaging is not recommended in the evaluation of uncomplicated acute rhinosinusitis. Limited evidence supports the use of intranasal corticosteroids in patients with acute rhinosinusitis. 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. ![]() 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 101☏ ). Most cases of acute rhinosinusitis are caused by viral infections associated with the common cold. Acute rhinosinusitis is further specified as bacterial or viral. Subtypes of rhinosinusitis include acute, subacute, recurrent acute, and chronic. Rhinosinusitis is one of the most common conditions for which patients seek medical care.
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