REBEL Core Cast 121.0 – Acute Sinusitis

Acute rhinosinusitis is a clinical diagnosis affecting approximately 20 million adults annually in the U.S., yet it remains a primary driver of unnecessary antibiotic prescriptions. While symptoms like nasal congestion, facial pressure, and purulent discharge are common, the vast majority of cases are viral, typically resolving within seven to ten days. Distinguishing bacterial from viral etiologies relies on clinical progression rather than mucus color; bacterial infections are characterized by symptoms persisting beyond ten days, severe illness lasting over three days, or "double sickening," where a patient worsens after initial improvement. First-line treatments for confirmed bacterial cases include amoxicillin or doxycycline for five to seven days. For viral cases, management focuses on symptomatic relief using intranasal saline and corticosteroids like fluticasone. Effective antibiotic stewardship requires reserving antimicrobial therapy for these specific clinical presentations to avoid over-prescription for viral illnesses.