Management of uncomplicated acute rhinosinusitis

Uncomplicated acute rhinosinusitis is usually a self-limiting condition. Antibiotic therapy may improve symptoms by days 3 to 7, but at day 10, there is no difference between patients treated with or without antibiotic therapyBurgstaller, 2016. Antibiotic therapy does not prevent spread of infection beyond the paranasal sinuses (see Complicated acute rhinosinusitis)Fokkens, 2020Lemiengre, 2018. The inappropriate use of antibiotic therapy for uncomplicated acute rhinosinusitis exposes patients and the community to the potential harms associated with antibiotics – see Types of adverse effects of antimicrobials for detailed advice.

Discuss the approach to management of uncomplicated acute rhinosinusitis with patients or carers:

• Offer symptomatic therapy.
• Reassure the patient that uncomplicated acute rhinosinusitis is usually self-limiting. Explain that symptoms often resolve or improve within 14 days, regardless of whether antibiotics are takenLemiengre, 2018.
• If an antibiotic prescription is requested, discuss the limited benefits and potential harms of antibiotic therapy (see above), and highlight that it is not possible to clearly identify patients who may benefit from antibiotic therapy. A decision aid to help these discussions is available from the Australian Commission on Safety and Quality in Health Care (ACSQHC).
• Ask the patient to return for review and reassessment of the diagnosis if symptoms do not improve in 10 days, or earlier if symptoms (particularly fever) worsen or if symptoms of complicated acute rhinosinusitis develop (see Clinical features of acute rhinosinusitis that indicate spread of infection beyond the paranasal sinuses)National Institute for Health and Care Excellence (NICE), 2017. Patients with complicated acute rhinosinusitis require intravenous antibiotic therapy and urgent surgical referral – see Management of complicated bacterial rhinosinusitis.
• Only consider antibiotic therapy for patients with uncomplicated acute rhinosinusitis whoNational Institute for Health and Care Excellence (NICE), 2017:
  • are systemically very unwell
  • have symptoms such as fever or facial pain that worsen after initially improving
  • do not improve after 10 days of symptomatic therapy.