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Acute bacterial rhinosinusitis

Background

Overview

Definition
ABRS, also known as acute sinusitis, is an inflammation of the nasal cavity and paranasal sinuses that lasts up to 4 weeks.
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Pathophysiology
ABRS is mostly caused by S. pneumoniae, Haemophilus influenza, and M. catarrhalis.
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Disease course
Nasal and paranasal infection results in ABRS, which causes clinical manifestations of nasal congestion and obstruction, purulent nasal discharge, facial pain or pressure, fever, fatigue, cough, hyposmia, ear pressure, headache, and halitosis. Disease progression may result in orbital and CNS complications.
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Prognosis and risk of recurrence
ABRS with ocular complications is associated with a 3.17% mortality rate.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of acute bacterial rhinosinusitis are prepared by our editorial team based on guidelines from the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS2020 2020), the American College of Physicians (ACP/CDC 2016), the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2015,2013), and the Infectious Diseases Society of America ...
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Screening and diagnosis

Diagnostic criteria
As per AAO-HNSF 2015 guidelines:
Diagnose ABRS in patients with:
symptoms or signs of acute rhinosinusitis (purulent nasal drainage accompanied by nasal obstruction, facial pain/pressure/fullness, or both) persisting without evidence of improvement for ≥ 10 days after the onset of symptoms
symptoms or signs of acute rhinosinusitis worsening within 10 days after an initial improvement (double worsening)
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Distinguish chronic rhinosinusitis and recurrent acute rhinosinusitis from isolated episodes of ABRS and other causes of sinonasal symptoms.
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Diagnostic investigations

Diagnostic imaging: as per AAO-HNSF 2015 guidelines, do not obtain radiographic imaging in patients meeting clinical criteria for acute rhinosinusitis unless a complication or alternative diagnosis is suspected.
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  • Sinus culture

Medical management

Antibiotic therapy, general principles: as per ACP/CDC 2016 guidelines, reserve antibiotic treatment for acute rhinosinusitis in patients with persistent symptoms for > 10 days, onset of severe symptoms or signs of high fever (> 39 °C) and purulent nasal discharge or facial pain lasting ≥ 3 consecutive days, or onset of worsening symptoms following a typical viral illness lasted 5 days that was initially improving (double sickening).
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  • Antibiotic therapy (first-line)

  • Antibiotic therapy (second-line)

  • Symptomatic treatment

  • Management of nonresponse to treatment

Follow-up and surveillance

Indications for specialist referral: as per IDSA 2012 guidelines, obtain specialist consultation with an otolaryngologist, infectious disease specialist, or allergist in the following situations:
patients who are seriously ill and immunocompromised
patients who continue to deteriorate clinically despite extended courses of antimicrobial therapy
patients who have recurrent bouts of acute rhinosinusitis with clearing between episodes.
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More topics in this section

  • Evaluation of recurrent acute rhinosinusitis