Treatment
Table 3. Summary of Key Action Statements (KAS)
Statement Action Strength
1a. Differential
diagnosis
Clinicians should distinguish presumed ABRS from
ARS caused by viral upper respiratory infections and
noninfectious conditions. A clinician should diagnose
ABRS when (a) symptoms or signs of ARS (purulent
nasal drainage accompanied by nasal obstruction,
facial pain-pressure-fullness, or both) persist without
evidence of improvement for ≥10 days beyond the
onset of upper respiratory symptoms, or (b) symptoms
or signs of ARS worsen within 10 days aer an initial
improvement (double worsening ).
S-B
1b. Radiographic
imaging and ARS
Clinicians should NOT obtain radiographic imaging
for patients who meet diagnostic criteria for ARS,
unless a complication or alternative diagnosis is
suspected.
R-B against
2. Symptomatic
relief of VRS
Clinicians may recommend analgesics, topical
intranasal steroids, and/or nasal saline irrigation for
symptomatic relief of VRS.
O-B/C
3. Symptomatic
relief of ABRS
Clinicians may recommend analgesics, topical
intranasal steroids, and/or nasal saline irrigation for
symptomatic relief of ABRS.
O-A, B, D
4. Initial
management of
ABRS
Clinicians should either offer watchful waiting
a
(without antibiotics) or prescribe initial antibiotic
therapy for adults with uncomplicated ABRS.
Watchful waiting should be offered only when there is
assurance of follow-up, such that antibiotic therapy is
started if the patient's condition fails to improve by 7
days aer ABRS diagnosis or if it worsens at any time.
R-A
5. Choice of
antibiotic for
ABRS
b
If a decision is made to treat ABRS with an antibiotic
agent, the clinician should prescribe amoxicillin with
or without clavulanate as first-line therapy for 5-10
days for most adults.
R-A
6. Treatment
failure for ABRS
If the patient worsens or fails to improve with the
initial management option by 7 days aer diagnosis or
worsens during the initial management, the clinician
should reassess the patient to confirm ABRS, exclude
other causes of illness, and detect complications. If
ABRS 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.
R-B
Note: Surgical management of CRS is not discussed in this guideline
because of insufficient evidence (e.g., randomized controlled trials) for
evidence-based recommendations.
