Think Twice about Antibiotics for

Acute Bacterial Sinusitis

Algorithm Showing the Interrelationship of Guideline Key Action Statements

Adult With Possible Sinusitis

Duration: ≤ 4 Weeks Duration: > 4 Weeks & < 12 Weeks Duration: ≥ 12 Weeks

ble 4 ble 7
1a Ta 7a Ta
No KAS KAS No
Meets Criteria “Subacute” Sinusitis Signs & Symptoms
for ARS? Excluded From Guideline Of CRS?
Clinician judgment as to whether patient Not
Viral Yes
URI Yes should be managed more like ARS or CRS CRS
e 7
1a Ta
ble 4
7b Tabl
No KAS Yes KAS Documented
Meets Criteria
Sinonasal
KAS 2
for ABRS? Inflammation? No
Viral ABRS
ARS Yes
Option to prescribe
symptomatic relief CRS
1b
Yes KAS Complication No
Suspected? KAS 10

Confirm The Presence OR

Obtain Radiologic Do Not Obtain Absence Of Nasal Polyps
Imaging Radiologic Imaging
KAS 11
KAS 3
Yes No Recommened Saline Nasal
Complication Recommend Symptomatic
Present? Irrigation &/OR Topical
Relief For ABRS
Intranasal Corticosteroids
Manage KAS 12
Complication KAS 4 Table 6
& ABRS Do Not Prescribe Topical
Offer Watchful Waiting* OR Systemic Antifungal
OR Prescribe Antibiotic Therapy
Based On Shared
Decision-Making
1
*Requires assurance of follow-up
KAS 8
Decision To Proceed With Decision To Proceed With
Watchful Waiting* Assess Patient For Chronic
Initial Antibiotic Therapy
Conditions That Would
KAS 5 Modify Management
Offer A Safety-Net OR Prescribe Amoxicillin, With KAS 8
Wait-&-See Antibiotic OR Without Clavulanate
Prescription Option Of Testing For
If penicillin allergy prescribe doxycycline Allergy & Immune Function
or a respiratory quinolone

6
KAS Treatment Yes Medical OR Surgical
6
Failure?** No KAS Treatment Yes Management As Appropriate
Failure?**
**Failure to improve by
7 days after diagnosis or
worsening at any time
ble 7
7a Ta
No KAS Recurrent 1 Make Decision
ABRS? Start or Stop
Connector
No Exclude Complications & Other Action
Causes Of Illness; If Diagnosis
ARS Acute RS
Management Complete Of ABRS Is Confirmed Prescribe
ABRS Acute Bacterial RS
An Alternate Antibiotic CRS Chronic RS
KAS Key Action Statement
Additional Resources:
RS Rhinosinusitis
Table 4: Acute Rhinosinusitis Definitions: www.entnet.org/ARS-definitions URI Upper Respiratory Infection
Table 6: Patient Information Sheet on Treating Acute Bacterial Rhinosinusitis: www.entnet.org/patient-information-ABRS

For more information and additional resources visit:

www.entnet.org/adultsinusitisCPG
Empowering otolaryngologist—head and neck surgeons to deliver the best patient care

www.entnet.org