Acute Sinusitis: Treatment Most patients with a diagnosis of acute rhinosinusitis based on clinical grounds improve without antibiotic therapy. The preferred initial approach in patients with mild to moderate symptoms of short duration is therapy aimed at facilitating sinus drainage, such as oral and topical decongestants, nasal saline lavage, and—in patients with a history of chronic sinusitis or allergies—nasal glucocorticoids. Adult patients who do not improve after 7 days, children who do not improve after 10–14 days, and patients with more severe symptoms (regardless of duration) should be treated with antibiotics (Table 31-1). . | Chapter 031. Pharyngitis Sinusitis Otitis and Other Upper Respiratory Tract Infections Part 4 Acute Sinusitis Treatment Most patients with a diagnosis of acute rhinosinusitis based on clinical grounds improve without antibiotic therapy. The preferred initial approach in patients with mild to moderate symptoms of short duration is therapy aimed at facilitating sinus drainage such as oral and topical decongestants nasal saline lavage and in patients with a history of chronic sinusitis or allergies nasal glucocorticoids. Adult patients who do not improve after 7 days children who do not improve after 10-14 days and patients with more severe symptoms regardless of duration should be treated with antibiotics Table 31-1 . Empirical therapy should consist of the narrowest-spectrum agent active against the most common bacterial pathogens including S. pneumoniae and H. influenzae . amoxicillin. No clinical trials support the use of broad-spectrum agents for routine cases of bacterial sinusitis even in the current era of drug-resistant S. pneumoniae. Up to 10 of patients do not respond to initial antimicrobial therapy sinus aspiration and or lavage by an otolaryngologist should be considered in these cases. Antibiotic prophylaxis to prevent episodes of recurrent acute bacterial sinusitis is not recommended. Surgical intervention and IV antibiotic administration are usually reserved for patients with severe disease or those with intracranial complications such as abscess or orbital involvement. Immunocompromised patients with acute invasive fungal sinusitis usually require extensive surgical debridement and treatment with IV antifungal agents active against fungal hyphal forms such as amphotericin B. Specific therapy should be individualized according to the fungal species and the individual patient s characteristics. Treatment of nosocomial sinusitis should begin with broad-spectrum antibiotics to cover common pathogens such as S. aureus and gram-negative bacilli. Therapy
