Table 4. Factors That Would Prompt Clinicians to Consider
Prescribing Amoxicillin-Clavulanate Instead of
Amoxicillin Alone for Initial Management of ABRS
Factor Comment
Situations in
which bacterial
resistance is likely
• Antibiotic use in the past month
• Close contact with treated individuals, health care providers, or a health
care environment
• Failure of prior antibiotic therapy
• Breakthrough infection despite prophylaxis
• Close contact with a child in a daycare facility
• Smoker or smoker in the family
• High prevalence of resistant bacteria in community
Presence of
moderate to
severe infection
• Moderate to severe symptoms of ABRS
• Protracted symptoms of ABRS
• Frontal or sphenoidal sinusitis
• History of recurrent ABRS
Presence of
comorbidity or
extremes of life
• Comorbid conditions, including diabetes; chronic cardiac, hepatic or
renal disease
• Immunocompromised patient
• Age >65 years
Table 5. Patient Instructions for Optimal Use of Topical Nasal
Steroid
a
Instructions
• Shake the bottle well
• Look down by bending your neck and looking towards the floor
• Put the nozzle just inside your nose using your right hand for the left nostril and your left
hand for the right nostril
• Aim towards the outer wall and squirt once or twice as directed; do not aim towards the
nasal septum (in the middle of the nose) to prevent irritation and bleeding
• Change hands and repeat for other side
• Do not sniff hard
a
Adapted from Scadding GK et. al. Clin Exp Allerg y. 2008;38(2):260-275.
circled "1" in the Figure is a connector, meaning that you proceed, in the direction of the arrows, from the
circled "1" to the next.
Clinician judgment as to whether patient should be managed more like ARS or CRS.
Option to prescribe symptomatic relief.
Requires assurance of follow-up.
penicillin allerg y, prescribe doxycycline or a respiratory quinolone.
Failure to improve by 7 days aer diagnosis or worsening at any time.
Figure 5. Adult with Possible Sinusitis Footnotes
