Figure 3. Algorithm for the Management of ABRS Signs and symptoms (any one):
> Persistent and not improving (≥ 10 days) > Severe (≥ 3-4 days) or > Worsening or "double-sickening" (≥ 3-4 days)
Risk for antibiotic resistance? NO Initiate 1st
antimicrobial therapy
line
Symptomatic management
YES Initiate 2nd
antimicrobial therapy
line
Improvement after 3-5 days
antimicrobial therapy*
Complete 5-7 days of
Improvement
antimicrobial therapy
Complete 5-7 days of
Risk for antibiotic resistance
> Age < 2 or > 65, day care > Prior antibiotics within the past month > Prior hospitalization past 5 days
> Comorbidities > Immunocompromised
* In children, complete 10-14 days of antimicrobial therapy.
improvement after 3-5 days Worsening or no
Broaden coverage or switch to different antimicrobial class
improvement after 3-5 days Refer to specialist
Worsening or no
> CT or MRI to investigate noninfectious causes or suppurative complications
Improvement after 3-5 days
antimicrobial therapy*
Complete 7-10 days of
Improvement
antimicrobial therapy
Complete 7-10 days of
> Sinus or meatal cultures for pathogen-specific therapy
