General Approach to Treatment

Initial management of rhinosinusitis focuses on symptom relief for patients with mild disease lasting less than 10 days. Clinicians often inappropriately prescribe antibiotics for clinically suspected rhinosinusitis that usually is viral, self-limiting, and infrequently complicated by bacterial infection. Studies comparing antimicrobials to placebo in ABRS report only modest symptom improvements but increased adverse events in patients treated with antibiotics and a high spontaneous improvement rate of over 70% at 7 to 12 days after diagnosis of nonsevere ABRS.28,30 Therefore, watchful waiting is an option in nonsevere ABRS for up to 7 days after diagnosis if adequate follow-up can be assured. Antibiotic therapy should be reserved for persistent, worsening, or severe ABRS: patients with moderately severe symptoms that have persisted for greater than 10 days or worsened within 10 days after initial improvement

23,24,28

and patients with severe disease regardless of duration. ' ' Empirical selection is often employed and should target likely pathogens because sinus cultures are rarely obtained.

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