Table 8. Comparison of major guidelines pertaining to the diagnosis of acute sinusitis and antibiotic therapy thereof.
| Category | Present guideline | IDSA (2012) | American Academy of Otolaryngology-Head and Neck Surgery (2015) | Korean Guideline for Antibiotics Usage in Children with Acute Upper Respiratory Infections (2016) | American Academy of Pediatrics (2013) |
|---|---|---|---|---|---|
| Diagnosis of acute bacterial sinusitis | One or more of the following symptoms/signs: | ||||
| 1. Severe condition: high fever of 39℃ or more, purulent nasal drainage, facial pain (≥3 days) | |||||
| 2. Persistent symptoms: nasal discharge, daytime cough (≥10 days) | |||||
| 3. Double sickening: new episode of fever, headache, cough, or nasal drainage while the above symptoms were showing improvement | |||||
| Imaging test | X-ray is not recommended for differentiating the cause of sinusitis; sinus CT or MRI is recommended when ocular or central nervous system complications are suspected | ||||
| Indications of antibiotic therapy | Antibiotics may be prescribed initially when acute bacterial sinusitis is diagnosed | Antibiotics may be prescribed when bacterial sinusitis is clinically diagnosed | Watchful waiting without antibiotic therapy, or antibiotics may be prescribed initially for acute bacterial sinusitis without complications | Antibiotics prescribed in severe conditions or when symptoms worsen | |
| When symptoms are persistent, choose between immediate prescribing of antibiotics or 3 days of watchful waiting | |||||
| First-line antibiotics | Standard or high dose of amoxicillin or amoxicillin/clavulanate | Standard or high dose of amoxicillin/clavulanate | Standard or high dose of amoxicillin or amoxicillin/clavulanate | Standard or high dose of amoxicillin/clavulanate | Standard or high dose of amoxicillin or amoxicillin/clavulanate |
| Penicillin allergy | Type 4 (e.g., rash): consider doxycycline or cephalosporins, clindamycin | Third-generation cephalosporins (with the exception of patients with type 1 penicillin hypersensitivity) | Third-generation cephalosporins | ||
| Type 1 (e.g., anaphylaxis): | |||||
| Non-beta-lactam antibiotics | |||||
| Duration of antibiotic therapy | 5–10 days or 4–7 days after improvement of symptoms/signs (first-line empirical antibiotics) | 5–7 days for adults without complications (10–14 days for children) | 5–10 days | Total 10–28 days, or 7 days after improvement of symptoms/signs | |
| Reassessment | If symptoms do not improve or worsen or new symptoms/signs develop within 72 hours of initiating treatment, reassess the initial treatment regimen | ||||
IDSA, Infectious Diseases Society of America; CT, Computer tomography; MRI, Magnetic Resonance Imaging.