Guideline issued on acute bacterial rhinosinusitis

The Infectious Diseases Society of America (IDSA) issued a new guideline last week on the diagnosis and management of acute bacterial rhinosinusitis, offering ways to distinguish bacterial from viral infection and stressing that antibiotic treatment is not necessary in the latter case.

The guideline was developed by an 11-member multidisciplinary expert panel that included representatives from several organizations, including ACP. It is the IDSA's first guideline on this topic and is intended for primary care physicians, especially those who see patients in community settings or in emergency departments.

The guideline describes the characteristics of bacterial versus viral sinus infections to help clinicians better differentiate between the two. Antibiotics are not recommended for most sinus infections because 90% to 98% are caused by viruses, the guideline said.

An infection probably has a bacterial cause and warrants antibiotics if symptoms last for at least 10 days and are not improving; if symptoms are severe, such as a temperature of at least 102° and facial pain for three to four successive days; and if symptoms worsen, usually after a viral upper respiratory infection of five or six days' duration that seemed to be improving, according to the guideline.

In patients who do have a bacterial sinus infection, the guideline recommends amoxicillin-clavulanate rather than amoxicillin alone, because clavulanate (a β-lactamase inhibitor) will improve the coverage of both ampicillin-resistant Haemophilus influenzae and Moraxella catarrhalis. Common antibiotics such as azithromycin, clarithromycin and trimethoprim-sulfamethoxazole are not recommended because of resistance issues. The guideline also recommends that antibiotic treatment in adults last five to seven days rather than 10 days to two weeks.

The full text of the guideline, which was published March 20 by Clinical Infectious Diseases, is available online.