Accurate diagnosis and appropriate treatment of acute bacterial rhinosinusitis: Minimizing bacterial resistance

Background: Antimicrobial resistance in respiratory pathogens has become a common clinical problem that has serious public health implications. Inappropriate use of antibiotics for the treatment of viral upper respiratory tract infections (URTIs) has contributed to the development of resistant microorganisms. Health care providers can help control the spread of resistance by limiting the use of antimicrobial agents to infections that meet clinical guidelines for a bacterial cause. Objective: This article examines the means of accurately diagnosing and appropriately treating acute bacterial rhinosinusitis (ABRS) in an effort to control increasing levels of resistance. Methods: This article discusses current treatment guidelines that provide the evidenced-based rationale for choosing the most appropriate antimicrobial agents for suspected ABRS in adults and children. An evidence-based approach can help minimize the public health threat posed by the continuing increase in microbial resistance. Results: Although definitive clinical criteria that differentiate between ABRS and viral URTI are lacking, careful evaluation of the duration and severity of symptoms provides a rational basis for diagnosing ABRS in primary care settings. Conclusions: Once a diagnosis of ABRS has been made, empiric antibiotic therapy may be justified. When it is, the first-line agent should be the narrowest-spectrum antibiotic that would be expected to eradicate the most common causative organisms. The antibiotic selection process should take into account prevailing patterns of resistance and the presence of risk factors for infection with resistant pathogens, as well as published evidence-based guidelines.