Recurrent acute rhinosinusitis

Acute rhinosinusitis is considered recurrent when patients have 4 or more distinct episodes per year without persistent symptoms between episodesFokkens, 2020. If symptoms persist for 12 weeks or longer, the condition is termed chronic rhinosinusitis – for management, see Chronic rhinosinusitis in the Respiratory guidelines.

Recurrent acute rhinosinusitis can be associated with contributing factors that influence patient management (eg allergic rhinitis, viral illness, nasal polyps, allergy, active and passive smoking)Fokkens, 2020. Encourage patients, parents or carers to stop smoking to help prevent future episodes of rhinosinusitis.

Offer symptomatic therapy, because recurrent acute rhinosinusitis has a significant impact on the patient’s day-to-day functioning and quality of life. For patients with persistent symptoms despite symptomatic therapy, consider referral to an otolaryngologist, particularly if a structural abnormality is suspected.

Manage each recurrence as for uncomplicated acute rhinosinusitisKaper, 2013. Do not prescribe long-term antibiotic therapy for recurrent acute rhinosinusitis before the patient has been reviewed by a specialist. Repeated courses of antibiotic therapy expose patients and the community to the potential harms associated with antibiotics – see Types of adverse effects of antimicrobials for detailed advice.