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March 2012
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New Guideline for Acute Bacterial Rhinosinusitis Now Available

IDSA’s new guideline for acute bacterial rhinosinusitis (ABRS) in children and adults is now available online. The guideline also appears in the April 15 issue of Clinical Infectious Diseases.

The guideline’s primary focus is to improve the use of first-line antibiotics for patients with a presumptive diagnosis of ABRS. The guideline’s intended audiences are primary care physicians in the community and the emergency department setting (e.g., family practitioners, internists, and pediatricians).

The reduction of inappropriate use of antimicrobial agents in patients with acute viral rhinosinusitis is emphasized. Additionally, the guideline provides guidance regarding the best clinical characteristics that are most helpful to distinguish bacterial from viral rhinosinusitis at the point of care.

Pitfalls of existing guidelines, due to the inability of current clinical criteria to differentiate bacterial from viral acute rhinosinusitis, are discussed. Gaps in quality evidence regarding empiric antimicrobial therapy for ABRS due to imprecise patient selection criteria are also identified.

The guideline provides key recommendations concerning initial treatment. For example, due to the recent increase in antibiotic resistance, the question regarding the preferred use of amoxicillin vs. amoxicillin-clavulanate for initial empiric antimicrobial therapy of ABRS in adults is addressed. In addition, recommendations regarding the preferred management strategy in patients who worsen despite 72 hours or fail to improve after three to five days of initial empiric antimicrobial therapy with a first-line regimen are provided. An algorithm for patient management based on temporal progression of patient responses is offered.

Therapeutic dilemmas encountered by primary care physicians, such as a lack of precision in current methods of diagnosis and imaging studies of presumed ABRS, are also discussed. 

Several key performance measures are identified in the guideline, including the percent of patients:

  • treated for sinusitis who met the criteria for therapy
  • treated for sinusitis for which the appropriate antimicrobial is used
  • treated for recommended duration of therapy
  • who fail initial therapy and have an appropriate culture obtained

The guideline is available online and is also being developed in both mobile device and pocketcard format for use at the point of care. These and other clinical tools, when available, can be accessed through the practice guidelines section of the IDSA website.
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