Diagnosis Duration of Treatment
ÎThe recommended duration of therapy for uncomplicated ABRS in adults is 5-7 days (WR-LM).
ÎIn children with ABRS, the IDSA still recommends a longer treatment duration of 10-14 days (WR-LM).
Adjunctive Treatment
ÎThe IDSA recommends intranasal saline irrigations with either physiologic or hypertonic saline as an adjunctive treatment in adults with ABRS (WR-LM).
ÎThe IDSA recommends intranasal corticosteroids as an adjunct to antibiotics in the empiric treatment of ABRS, primarily in those with a history of allergic rhinitis (WR-M).
ÎNeither topical nor oral decongestants and/or antihistamines are recommended as adjunctive treatment in patients with ABRS (SR-LM).
Secondary Treatment
ÎThe IDSA recommends an alternative management strategy if symptoms worsen after 48-72 hours of initial empiric antimicrobial therapy or fail to improve despite 3-5 days of initial empiric antimicrobial therapy (SR-M).
ÎEvaluated patients who clinically worsen despite 72 hours, or fail to improve after 3-5 days, of empiric antimicrobial therapy with a first-line agent for the possibility of resistant pathogens, a noninfectious etiology, structural abnormality or other causes for treatment failure (SR-L).
ÎThe IDSA recommends that cultures be obtained by direct sinus aspiration rather than by nasopharyngeal swabs in patients with suspected sinus infection who have failed to respond to empiric antimicrobial therapy (SR-M).
ÎConsider endoscopically guided cultures of the middle meatus as an alternative in adults, but their reliability in children has not been established (WR-M).
ÎNasopharyngeal cultures are unreliable and are NOT recommended for the microbiologic diagnosis of ABRS (SR-H).
ÎIn patients with ABRS suspected to have suppurative complications, the IDSA recommends axial and coronal views of contrast-enhanced computerized tomography (CT) rather than magnetic resonance imaging (MRI) to localize the infection and to guide further treatment (WR-L).
