ÎPatients who are:
> seriously ill and immunocompromised > continue to deteriorate clinically despite extended courses of antimicrobial therapy or > have recurrent bouts of acute rhinosinusitis with clearing between episodes
should be referred to a specialist (such as an otolaryngologist, infectious disease specialist or allergist) for consultation. (Since this is a "good clinical practice" statement rather than a recommendation, it is not further graded.)
Figure 1. The Natural History and Time-Course of Fever and Respiratory Symptoms Associated with an Uncomplicated Viral Upper Respiratory Infection in Children
Figure 2. Time to Bacterial Eradication From the Maxillary Sinus in Patients with ABRS Following Initiation of Therapy with Respiratory Fluoroquinolones (N = 50; Multiple Pathogens Were Isolated From Some Patients)
125 100 75 50 25 0
Time to eradication of pathogens from the maxilary sinus
S. pneumoniae (23) H. influenzae (26) M. catarrhalis (8)
0
1
2
3 Days to eradication
4
5
Percent survival
