Version July 2025
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.
¶ Patients in whom observation is selected should be able to reliably return for follow-up or be in close contact with their providers if additional care is needed within the next 7 days. In some cases (eg, to save the time and inconvenience of a follow-up visit), we provide patients a prescription for antibiotics at the time of ABRS diagnosis with instructions to fill it only if they worsen or do not improve after seven days.
Δ We have a lower threshold to initiate antibiotics in younger patients (late teens to early twenties), as infection can spread more easily through the frontal and orbital bones in this group.
