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Diagnosing and Treating Acute Bacterial Rhinosinusitis: New Guidelines from the Infectious Diseases Society of America

Posted on by CDC's Safe Healthcare Blog
Anthony W. Chow MD, FRCPC, FACP
Anthony W. Chow MD, FRCPC, FACP

Author – Dr. Anthony W. Chow, MD.
University of British Columbia and Vancouver Hospital

Sinus infections cause inflammation of both the sinuses and nasal cavity. The infections can sometimes last for weeks and can be very uncomfortable. They are quite common – in fact, nearly one in seven adults are diagnosed with a sinus infection each year.

My coauthors and I developed the Infectious Diseases Society of America (IDSA)’s Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults to help physicians make sense of how to best diagnose and treat rhinosinusitis.

Our goals for the guideline are to inform physicians regarding the appropriate diagnosis and management of rhinosinusitis and to reduce inappropriate and unnecessary use of antibiotics. Inappropriate use can cause harm by fostering antibiotic resistance, unnecessarily exposing patients to drug side effects and adding cost.

During our extensive review of the existing evidence on the topic, we found that the vast majority of sinus infections – 90% to 98% – are caused by viruses. This means that antibiotics are not effective in treating most cases of rhinosinusitis. And yet, sinus infections are the fifth leading reason for antibiotic prescriptions nationwide.

We provide specific characteristics of the illness to help doctors distinguish bacterial from viral sinus infections, and provide guidance on which antibiotics are best for appropriate and effective treatment. If symptoms last for 10 days without improvement, or include fever of 102 degrees or higher with nasal discharge and facial pain lasting three to four days, or if symptoms seem to improve after 4 to 7 days only to worsen again, the infection is likely bacterial and should be treated with antibiotics.

The guidelines advise against the current standard of care, amoxicillin, and instead recommend using amoxicillin-clavulanate for treatment if a bacterial infection is suspected. The addition of clavulanate helps to overcome resistance by inhibiting an enzyme that breaks down the antibiotic. This recommendation is a departure from previous rhinosinusitis guidelines, but was made to address antibiotic resistance and reflect the increased use of pneumococcal vaccines, which have changed the pattern of bacteria that cause sinus infections.

Read the full-text “IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults online at http://cid.oxfordjournals.org/content/54/8/1041.full.pdf+html or pick up the April 15 issue of Clinical Infectious Diseases.

CDC information about sinus infections can be found at: http://www.cdc.gov/getsmart/antibiotic-use/URI/sinus-infection.html

Symptom relief tips: http://www.cdc.gov/getsmart/antibiotic-use/symptom-relief.html

Posted on by CDC's Safe Healthcare Blog

4 comments on “Diagnosing and Treating Acute Bacterial Rhinosinusitis: New Guidelines from the Infectious Diseases Society of America”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Its really problematic while anyone facing the problems of sinuses and nasal cavity. They are trying to overcome it but failure again and again and unable to understand why it is happening. Your article will help us to collect such information and to know about it briefly. We know due to such problem we can face many other diseases like :esophageal cancer treatment and many more.

    The main cause of sinus is Virus infection. It also the main cause of fever. So the treatment of the diseases are mandatory.

    There is extensive literature in the Scandinavian literature as well as some recently in the US indicating that without imaging studies, the clinician is misled to overtreat when using classical history and physical dx as criteria. I congratulate you on again raising the issue of overtreatment and differentiation of viral and bacterial.
    Robert M.Meyers M.D University of Illinois

    I have never been plagued by sinus infections BUT recently an MRI of my brain revealed that I had what my Cardiologist called a “sinus infection”. This caused me to rethink what the real (broader?)definition f a sinus infection is. It was very educational. All of the sinus cavities in my head were infected yet I did not feel I had a sinus infection….I was not sneezing, stuffed up, etc. However I have been having rather nasty headaches and that physician felt the sinus infection may be the reason. I was referred to an ENT physician whom I have not seen yet.

    To digress, my Urologist has put me on a daily dose of 50MG of an antibiotic!!!! It is Nitro. I do not feel comfortable about taking antibiotics in this manner but I do not see him for three months and I suppose he wants to see if it will impact a mysterious chronic urinary tract pathology. I will go search the literature for long term use of antibiotics. I am especially concerned because I was exposed to MRSA in an ER via an infected IV in 2007 and that heightened my concern about overuse of antibiotics, viruses and bacteria, etc. Recommend reading the book The Coming Plague, written about 10 years ago but still very relevant, disturbing and important.

    It is only if we are armed with knowledge that we can steal ourselves against potential pandemics. We must all be very careful about use of antibiotics. Also I do not understand why so many people are plagued with sinus infections…I do not recall that years ago. If it has gotten worse I wonder why and what we can do about it.

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