This handout is for acute rhinosinusitis (viral vs abrs; complications). Your care team identified this based on: nasal obstruction/congestion + anterior or posterior purulent discharge + facial pain/pressure/fullness (cardinal ars symptom cluster; ≥2 of these = rhinosinusitis) (payne aao-hns 2025 pmid 40742114; epos 2020 pmid 32077450).
Other reasons your team may use this plan: uri-type symptoms persisting ≥10 days without improvement — the persistent-illness abrs pattern (chow idsa 2012 pmid 22438350; wald aap 2013 pmid 23796742); "double-sickening" — new fever / worsening discharge / worsening facial pain after an initially improving uri (chow idsa 2012 pmid 22438350; epos 2020 pmid 32226949); severe onset — high fever (≥39 °c / 102.2 °f) with purulent nasal discharge for ≥3-4 consecutive days at illness onset (chow idsa 2012 pmid 22438350; wald aap 2013 pmid 23796742).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| watchful_waiting_no_antibiotic_with_7day_safety_net | — | — | — | Payne AAO-HNS 2025 (PMID 40742114) — watchful waiting (symptomatic care + safety-net follow-up if not improving by 7 d or worsening) for ALL uncomplicated ABRS; Lemiengre Cochrane 2018 (PMID 30198548) — ~46% cured at 1 wk / ~64% at 14 d without antibiotics; antibiotic NNTB ~19 (clinical dx), NNH ~8 |
| intranasal_corticosteroid_eg_fluticasone_or_mometasone | — | — | — | Payne AAO-HNS 2025 / EPOS 2020 (PMID 32077450) — intranasal corticosteroid is an option for symptom relief in viral ARS and ABRS (modest benefit, faster symptom resolution); RxCUI deferred — multiple branded INS products, no single confident MIN |
| isotonic_saline_nasal_irrigation | — | — | — | Payne AAO-HNS 2025 / EPOS 2020 — saline irrigation/spray is a low-harm symptomatic option for ARS |
| acetaminophen | 650-1000 mg | PO | q6h PRN | Payne AAO-HNS 2025 — analgesics/antipyretics for pain and fever in viral ARS and ABRS (NSAID alternative if no contraindication) |
Plan: Acute rhinosinusitis — watchful-waiting-first ladder (viral ARS → uncomplicated ABRS → penicillin-allergy → complicated/IV)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Educate on natural history (viral ARS self-limited; antibiotic NNT ~11-15, NNH ~8 for adverse effects — Lemiengre Cochrane 2018; Young Lancet 2008) and antibiotic stewardship. Define recurrence (≥4 ABRS episodes/yr with symptom-free intervals) and the CRS boundary (symptoms ≥12 wk with objective sinonasal inflammation → CRS pathway / ENT referral). Return precautions: orbital swelling, visual change, severe/worsening headache, neck stiffness, altered mentation → emergency re-presentation. ENT referral for recurrent ARS, complications, anatomic factors, immunodeficiency, or chronic transition.
Guideline: AAO-HNS Clinical Practice Guideline: Adult Sinusitis Update 2025 (Payne et al, Otolaryngol Head Neck Surg, PMID 40742114; executive summary 40741969 — CURRENT US authority, REPLACES Rosenfeld 2015 PMID 25832968) + IDSA 2012 Acute Bacterial Rhinosinusitis (Chow et al, CID, PMID 22438350) + EPOS 2020 European Position Paper on Rhinosinusitis (Fokkens et al, Rhinology, PMID 32077450; exec 32226949) + AAP Pediatric Acute Bacterial Sinusitis 2013 (Wald et al, Pediatrics, PMID 23796742) + Cochrane antibiotics for acute rhinosinusitis (Lemiengre 2018, PMID 30198548) + Young IPD meta-analysis (Lancet 2008, PMID 18342685)