Cultures obtained by direct sinus aspiration or by flexible nasal endoscopy should be obtained in patients who fail first- and second-line antibiotic therapy to assess for resistant organisms and/or persistent bacterial infection. Nasopharyngeal cultures are unreliable and are not recommended.
Sinus radiographs have no clinical utility in the evaluation and management of sinusitis, and are therefore not recommended. If suppurative complications from sinusitis are suspected, contrast-enhanced CT is the best imaging modality.
Specialist referral may be required in selected patients who have persistent, severe, or recurrent disease.
A useful management algorithm is provided in the full-text guideline.
Reference
Chow A. et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. (Clin. Infect. Dis. 2012;54:e72-e112).
Dr. Agarwal is an assistant professor of medicine at the University of Arkansas, Little Rock. Dr. Golden is medical director of Arkansas Medicaid and professor of medicine and public health at the University of Arkansas. Dr. Hopkins is director of the division of general internal medicine at the University of Arkansas. E-mail them at imnews@elsevier.com. They reported having no relevant financial conflicts.