Statement 5: Choice of Antibiotic for Acute Bacterial Rhinosinusitis (ABRS):

“If a decision is made to treat ABRS with an antibiotic agent, the clinician should prescribe amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days for most adults.” (Recommendation)

Should the decision be made to treat for bacterial sinusitis, this statement helps the clinician choose an appropriate antibiotic regimen. Patients at risk for antibiotic resistance, with moderate to severe infection, or with medical co-morbidities and extremes of age may prompt the clinician to opt for amoxicillin alone or in combination with clavulanate. For penicillin-allergic patients, doxycycline or a respiratory fluoroquinolone (levofloxacin or moxifloxacin) is recommended.

This systematic review encompasses most aspects of the diagnosis, workup, and treatment of both acute and chronic sinusitis. While some recommendations are specific to primary care settings, many are pertinent to the practice of EM. Used in practice, they may aid in shared decision-making for sinusitis management, and they have the potential to guide providers toward more judicious use of antibiotics and alleviate unnecessary costs and potential harms in overtreatment.

Dr. Ingalsbe is a third-year emergency medicine resident physician at the Denver Health Residency in Emergency Medicine in Colorado.

References

1. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015;152(2 Suppl):S1-S39.

2. Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: national health interview survey, 2012. Vital Health Stat. 2014;10:1-171.

3. Sinus and Allergy Health Partnership (SAHP). Antimicrobial treatment guidelines for acute bacterial rhinosinusitis. Otolaryngol Head Neck Surg. 2004;130(suppl):1-45.

4. American College of Emergency Physicians. Choosing Wisely. Avoid prescribing antibiotics in the emergency department for uncomplicated sinusitis. October 27, 2014.