Observation versus antimicrobial therapy for uncomplicated acute bacterial rhinosinusitis in immunocompetent adults

ABRS: acute bacterial rhinosinusitis; ARS: acute rhinosinusitis.

* The diagnosis of ARS, which may be bacterial or viral, can be made clinically and requires the presence of purulent nasal discharge for <4 weeks and severe congestion and/or facial pain/pressure. The diagnosis of ABRS can also be made clinically and requires that symptoms be present for ≥10 days or that signs and symptoms of ARS initially improve but then worsen, typically over a 10-day time period ("double worsening"). For ABRS to be uncomplicated, there should be no evidence of extension of infection beyond the sinuses into the surrounding skin, soft tissue, bone, or central nervous system.

¶ Because a substantial number of patients with clinically diagnosed ABRS improve with supportive care alone, we generally provide symptomatic care and observe patients who can reliably return for follow-up or be in close contact with their providers if additional care is needed within the next 7 days.