A Brief Sysnopsis of AFP's "Practice Guidelines : IDSA Releases Guidelines for Management of Acute Bacterial Rhinosinusitis"

 A brief synopsis of "Practice Guidelines : IDSA Releases Guidelines for Management of Acute Bacterial Rhinosinusitis"

Am Fam Physician. 2013 Mar 15;87(6):445-449.

http://www.aafp.org/afp/2013/0315/p445.html

     Every patient who has a cold, wants antibiotics. It is important to know when an infection is viral and when it is bacterial. Symptoms to look for are; no improvement for 10 days, fever of at least 102'F, purulent nasal discharge or facial pain for 3 days, or worsening signs or symptoms. The first line antibiotic is amoxicillin/clavulanate in both children and adults. Doxycycline is a good alternative. The second-line therapy of a third-generation cephalosporin plus clindamycin can be used in children with "non-type I penicillin allergy" or a "non-type I hypersensitivity" to penicillin. Levofloxacin is recommended in children with type I hypersensitivity to penicillin. If an adult has a penicillin allergy, doxycycline or a respiratory fluoroquinolone may be used. Therapy should be given to adults for 5-7 days, and 10-14 days in children.
     If the patient does not improve after 3-5 days or worsens within 2-3 days, the treatment must be reevaluated. Cultures should be taken, preferably by direct sinus aspiration, to rule out resistant bugs. Structural abnormalities should be evaluated as well. If imaging is needed, CT is recommended over MRI. You should also consider referring to a specialist.