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Treatment
Figure 5. Adult with Possible Sinusitis
"Subacute" sinusitis
excluded from guideline
a
Duration >4 w and <12 w Duration ≤4 w Duration ≥12 w
e circled
first circled
a
Clinician
b
Option
c
Requires
d
If penicillin
e
Failure
Signs and
symptoms of
CRS?
NO
NO
YES
Meets
criteria for
ARS?
Viral
URI
Not
CRS
KAS
1a
Table
1
KAS
7a
Table
1
Meets
criteria for
ABRS?
KAS
1a
Table
1
Documented
sinonasal
inflammation?
KAS
7b
Table
2
NO
Viral
URI
b
ABRS
Complication
suspected?
KAS 2
YES
NO
KAS
1b
Obtain radiologic
imaging
Do not obtain
radiologic imaging
Complication
present?
YES
Manage
complication
and ABRS
Recommend
symptomatic
relief for ABRS
KAS 3
NO
CRS
YES
NO
Confirm the
presence or absence
of nasal polyps
KAS 10
Recommend saline nasal
irrigation and/or topical
intranasal corticosteroids
KAS 11
Do not prescribe
topical or systemic
antifungal therapy
KAS 12
KAS 8
KAS 9
Medical or surgical
management as
appropriate
Offer watchful
waiting
c
OR prescribe
antibiotic based on
shared decision-making
KAS 4 Table 7
1
Decision to
proceed with
watchful waiting
c
Offer a safety-net
or wait-and-see
antibiotic Rx
Prescribe
amoxicillin, with or
without clavulanate
d
KAS
6
YES
Treatment
failure?
e
KAS
6
Recurrent
ABRS?
KAS
7a
Table
1
NO
1
NO
Treatment
failure?
e
Exclude complications and other causes of illness. If diagnosis
of ABRS is confirmed prescribe an alternate antibiotic
Management complete
NO
Assess patient for
chronic conditions
that would modify
management
Option of testing
for allerg y and
immune function
YES
Decision to
proceed initial
antibiotic therapy
KAS 5 Table 4
