Acute Sinusitis in Adults

Acute bacterial sinusitis — purulent nasal discharge and nasal obstruction; facial pain, pressure, or fullness; or both — persists for 10 days or more with no improvement or worsens within 10 days after improvement. Watchful waiting and antibiotic therapy are described. Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. Stage A 28-year-old woman presents with an acute onset of nasal discharge, a frontal headache, and a temperature of 39.5°C. Her temperature normalizes within 2 days, but after 12 days she has bothersome nasal congestion and purulent postnasal drip that does not improve. Does this pattern of illness suggest acute bacterial sinusitis or a persistent viral upper respiratory infection? How should this case be managed? The Clinical Problem Sinusitis, which is defined as symptomatic inflammation of the paranasal sinuses and nasal cavity, is reported by nearly 30 million adults annually in the United States. 1 Sinusitis is classified according to duration . . .