4
Key Action Statements
Table 2. Summary of Guideline Key Action Statements (KAS)
Statement Action Strength
1a. Differential
diagnosis
Clinicians should distinguish presumed
ABRS from acute rhinosinusitis caused
by viral upper respiratory infections and
noninfectious conditions. A clinician should
diagnose ABRS when (a) symptoms or
signs of acute rhinosinusitis (purulent nasal
drainage accompanied by nasal obstruction,
facial pain-pressure-fullness, or both) persist
without evidence of improvement for at least
10 days beyond the onset of upper respiratory
symptoms, or (b) symptoms or signs of acute
rhinosinusitis worsen within 10 days aer an
initial improvement (double worsening ).
Strong
recommendation
1b. Radiologic
imaging and ARS
Clinicians should not obtain radiologic
imaging for patients who meet diagnostic
criteria for ARS, unless a complication or
alternative diagnosis is suspected.
Recommendation
(against)
2. Symptomatic relief
of VRS
Clinicians may recommend analgesics,
topical intranasal steroids, and/or nasal saline
irrigation for symptomatic relief of VRS.
Option
3. Symptomatic relief
of ABRS
Clinicians may recommend analgesics,
topical intranasal steroids, and/or nasal saline
irrigation for symptomatic relief of ABRS.
Option
4. Initial
management of
ABRS
Clinicians should offer watchful waiting
(without antibiotics) for adults with
uncomplicated ABRS with assurance of
follow-up. e duration of watchful waiting
may depend on the factors and timing under
which the diagnosis was originally made.
Recommendation
5. Choice of
antibiotic for
ABRS
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 5–7 days for most adults.
Recommendation
6. Treatment failure
for ABRS
If the patient fails to improve or worsens
despite being on an appropriate antibiotic
for 3–5 days, the clinician should reassess
the patient to confirm ABRS, exclude other
causes of illness, and detect complications.
If ABRS is confirmed, the clinician should
change the antibiotic.
Recommendation
7a. Diagnosis of CRS
or RARS
Clinicians should distinguish CRS and RARS
from isolated episodes of ABRS and other
causes of sinonasal symptoms.
Recommendation
Note: Surgical management of CRS is not discussed in this guideline
because of insufficient evidence (e.g., randomized controlled trials) for
evidence-based recommendations.
