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Adult Sinusitis

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3 timesasefasfasdfasfasdfasdfasdfasfasdfasdfasdfasddf 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

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