Experts update best practices for treating the 1 in 8 US adults suffering from sinusitis

An updated clinical practice guideline from the American Academy of Otolaryngology--Head and Neck Surgery Foundation published in Otolaryngology-Head and Neck Surgery identifies quality improvement opportunities and explicit actionable recommendations for clinicians managing adult sinusitis, including a greater focus on patient education and patient preference.

"More than ever before, there is a prominent role for shared decision-making between patients and clinicians when managing adult sinusitis--especially in deciding whether to use antibiotics for acute bacterial sinusitis or to instead try 'watchful waiting' to see if a patient can fight the infection on his or her own," explained Richard M. Rosenfeld, MD, MPH, who chaired both the 2007 guideline and the 2015 update.

"Intuitively clinicians often feel that sicker patients benefit more from antibiotics, but our recommendation is that watchful waiting or antibiotics are both appropriate. This empowers patients and clinicians to use antibiotic judiciously, reserving antibiotics for cases that get worse or don't improve over time."

Those shared decisions also are important regarding sinusitis symptom relief options such as pain relievers, topical intranasal steroids, and nasal saline irrigation.

Other differences between the 2007 guideline and the 2015 update include:

  • more explicit details about the role of pain relievers, topical intranasal steroids, and/or nasal saline irrigation for symptomatic relief of acute bacterial sinusitis;
  • a recommendation of amoxicillin with or without clavulanate when antibiotics are prescribed, while the prior guideline recommended amoxicillin alone;
  • several statements about chronic sinusitis, the management of which was not discussed in the 2007 guideline.

This evidence-based clinical guideline for adult sinusitis was updated by a multi-disciplinary panel of experts in otolaryngology-head and neck surgery, infectious disease, family medicine, allergy and immunology, advanced practice nursing, and a consumer advocate.