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Guidelines
Acute Uncomplicated Bacterial Rhinosinusitis (ABRS)

Acute Uncomplicated Bacterial Rhinosinusitis (ABRS)

Microbiology

Bacterial vs. Viral Infection

  • The majority of cases of acute sinusitis are viral and resolve within 5 to 7 days without the need for antibiotics
  • Only 0.5 – 2% of viral upper respiratory infections are complicated by bacterial infection

Clinical Pearls

Treatment Criteria & Considerations

  • Purulent nasal drainage accompanied by nasal obstruction, facial pain-pressure-fullness, or both lasting less than 4 weeks

  • Colour of nasal discharge or sputum is related to the presence of neutrophils, not bacteria, and should not be used alone to diagnose bacterial rhinosinusitis

  • However, it is important to note that facial pain-pressure-fullness WITHOUT purulent nasal discharge is not sufficient for a diagnosis of acute bacterial rhinosinusitis.

Clinical diagnosis and differentiation of acute bacterial from viral rhinosinusitis is based on the characteristic patterns of clinical presentations taking into account duration of symptoms, severity of illness, temporal progression and "double-sickening" in the clinical course

The following clinical presentations (any of the 3) are recommended for identifying patients with acute bacterial vs. viral rhinosinusitis:

  1. Onset with persistent symptoms or signs compatible with acute rhinosinusitis, lasting for ≥10 days without any evidence of clinical improvement.
  2. Onset with severe symptoms or signs of high fever (≥39°C) and purulent nasal discharge or facial pain lasting for at least 3 to 4 consecutive days at the beginning of illness.
  3. Onset with worsening symptoms or signs characterized by the new onset of fever, headache or increased nasal discharge following a typical viral upper respiratory infections that lasted 5-6 days and were initially improving ("double sickening").

Watchful Waiting in the Presence of Complicating Factors

  • These guideline recommendations are not intended for patients with complicating factors, such as immune deficiency or uncontrolled diabetes
  • Watchful waiting should not be used for patients with complicating factors and they should be started promptly on appropriate antimicrobial therapy

More Information

Guideline content derived from:

  • NB Provincial Health Authorities Anti-Infective Stewardship Committee. Antimicrobial Therapy for Acute Uncomplicated Bacterial Rhinosinusitis (ABRS). 09-2018.
  1. Chow AW, Benninger MS, Brook I et al. IDSA Clinical Practice Guidelines for Acute Bacterial Rhinosinusitis in Children and Adults. Clin Infect Dis. 2012 Apr;54(8):e72-e112
  2. Blondel-Hill E. & Fryters S. (2012). Bugs & Drugs An Antimicrobial/Infectious Diseases Reference. Alberta Health Services.
  3. Anti-infective Review Panel. Anti-infective guidelines for community-acquired infections. Toronto: MUMS Guideline Clearhouse; 2013.
  4. Kaplan A. Canadian guidelines for acute bacterial rhinosinusitis – Clinical summary. Can Fam Physician. 2014 Mar;60(3):227-34. C
  5. Peters AT, Pector S, Hsu J et al. Diagnosis and management of rhinosinusitis: a practice parameter update. Ann Allergy Asthma Immunol 113(2014):347-385
  6. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS et al. Clinical Practice (Update): Adult Sinusitis. Otolaryngology – Head and Neck Surgery 2015;152(2S):S1 – S39
  7. Desrosiers M, Evans GA, Keith PK et al. Canadian clinical practice guidelines for acute and chronic rhinosinusitis. Alergy, Asthma & Clinical Immunology 2011;7:2