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Rhinosinusitis

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Figure 3. Algorithm for the Management of ABRS Signs and symptoms (any one): > Persistent and not improving (≥ 10 days) > Severe (≥ 3-4 days) or > Worsening or "double-sickening" (≥ 3-4 days) Risk for antibiotic resistance? NO Initiate 1st antimicrobial therapy line Symptomatic management YES Initiate 2nd antimicrobial therapy line Improvement after 3-5 days antimicrobial therapy* Complete 5-7 days of Improvement antimicrobial therapy Complete 5-7 days of Risk for antibiotic resistance > Age < 2 or > 65, day care > Prior antibiotics within the past month > Prior hospitalization past 5 days > Comorbidities > Immunocompromised * In children, complete 10-14 days of antimicrobial therapy. improvement after 3-5 days Worsening or no Broaden coverage or switch to different antimicrobial class improvement after 3-5 days Refer to specialist Worsening or no > CT or MRI to investigate noninfectious causes or suppurative complications Improvement after 3-5 days antimicrobial therapy* Complete 7-10 days of Improvement antimicrobial therapy Complete 7-10 days of > Sinus or meatal cultures for pathogen-specific therapy

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