Acute rhinosinusitis: When to prescribe an antibiotic

Area of Science:

• Otolaryngology
• Infectious Diseases
• Pharmacology

Background:

• Acute rhinosinusitis (ARS) is frequently diagnosed, leading to widespread antibiotic prescribing.
• A significant proportion of ARS cases are viral, making antibiotic treatment unnecessary and contributing to antimicrobial resistance.
• Clinical guidelines recommend antibiotics only for bacterial ARS.

Purpose of the Study:

• To determine the necessity of antibiotic prescriptions for acute rhinosinusitis.
• To provide guidance on appropriate antibiotic selection when indicated for bacterial acute rhinosinusitis.

Main Methods:

• Review of current clinical guidelines and evidence-based research on acute rhinosinusitis management.
• Analysis of diagnostic criteria for bacterial versus viral sinusitis.
• Evaluation of antibiotic efficacy and safety profiles for common pathogens.

Main Results:

• The majority of antibiotic prescriptions for ARS are indeed unnecessary.
• Antibiotics are indicated for acute bacterial rhinosinusitis, characterized by specific diagnostic criteria (e.g., severe symptoms, worsening symptoms, or prolonged duration).
• First-line antibiotic choices often include amoxicillin or amoxicillin-clavulanate, with alternatives for penicillin-allergic patients.

Conclusions:

• Judicious antibiotic prescribing is crucial to combat antimicrobial resistance in acute rhinosinusitis.
• Accurate diagnosis differentiating viral from bacterial ARS is key to appropriate management.
• Specific antibiotic regimens should be reserved for confirmed or highly suspected cases of bacterial acute rhinosinusitis.