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A 36-year-old woman presents with 10 days of nasal congestion, facial pressure, purulent nasal discharge, and headache. Symptoms worsened after initial improvement. No fever or cough. What is the evidence-based stepwise approach to diagnosing and managing acute rhinosinusitis in adults?
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Differentiate viral from bacterial rhinosinusitis
Assess duration and pattern of symptoms
Check for double worsening or severe onset
Avoid antibiotics for uncomplicated viral cases
Start amoxicillin-clavulanate if bacterial signs present
Consider imaging only if complications suspected
Recommend nasal saline irrigation and intranasal steroids
Educate on symptom course and red flags
Reassess if no improvement after 7 days of treatment
Refer to ENT for persistent or recurrent cases
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1
Assess duration and pattern of symptoms
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2
Differentiate viral from bacterial rhinosinusitis
media1
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3
Check for double worsening or severe onset
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pic1
4
Avoid antibiotics for uncomplicated viral cases
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5
Start amoxicillin-clavulanate if bacterial signs present
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6
Recommend nasal saline irrigation and intranasal steroids
media1
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7
Educate on symptom course and red flags
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8
Consider imaging only if complications suspected
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9
Reassess if no improvement after 7 days of treatment
media1
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10
Refer to ENT for persistent or recurrent cases
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Rhinosinusitis
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