New practice guideline for rhinosinusitis

New practice guideline for rhinosinusitis

The Infectious Diseases Society of America has published its first Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. The guideline points out the difficulty in distinguishing bacterial vs viral sinus infections. The following are suggestive of bacterial infection: persistent symptoms of sinusitis lasting more than 10 days without evidence of improvement; onset of severe symptoms or signs with high fever, purulent discharge, or facial pain lasting at least 3-4 consecutive days; or onset with worsening symptoms or signs characterized by new onset of fever, headache, or increased nasal discharge following a viral URI. The guideline recommends empiric antibiotic therapy with amoxicillin-clavulanate rather than amoxicillin alone in both children and adults. Children should be treated for 10-14 days while adults should be treated for 5-7 days. The guideline further recommends beta-lactam agents for treatment of sinusitis rather than respiratory floroquinolones, macrolides, trimethoprim-sulfamethoxazole, or second- or third-generation oral cephalosporins due to emerging resistance patterns. Doxycycline may be used as an alternative. (Clin Inf Dis 2012;54:e72-e112. DOI: 10.1093/cid/cis370).