Table 1.
Acute rhinosinusitis treatment and recommendations for both adults and children based slightly modified from EPOS2020 (Fokkens 2020)
| Acute viral rhinosinusitis (common cold) | Acute post-viral rhinosinusitis | Acute bacterial rhinosinusitis | |
|---|---|---|---|
| Antibiotics |
Recommendation against (1a -) in children and adults |
Recommendation against (1a -) in children and adults |
Careful patient selection to avoid unnecessary use. Recommendation in adults (1a)a No recommendation in children (1a -) |
| Nasal corticosteroids | Recommendation against (1a -) |
Are effective reducing the symptoms, but as a self-limiting disease they are optional in adults (1a) No advise can be made in children (low quality of evidence) |
No studies |
| Systemic corticosteroids | No studies | Recommendation against (1a -) in adults | Insufficient datab |
| Antihistamines | Short-term beneficial effect the overall symptoms in adults (1a) | Low quality of evidence studies, no additive beneficial effect in studies in adults and children | Low quality of evidence studies, no additive beneficial effect in studies in adults and children |
| Nasal decongestants | Multiple doses may have a small positive effect on nasal congestion in adults (1a) without increase the risk of adverse events | May be effective in improving mucociliary clearance in the acute phase. Absence of clinically relevant data | Insufficient data |
| Antihistamine + nasal decongestant + analgesic | Some general benefit in adults and older children with common cold (1a). No evidence in young children | Insufficient data | No studies |
| Ipratropium bromide | Improves rhinorrea but has no effect on nasal obstruction (1a) | Insufficient data | Insufficient data |
| Saline irrigation | Slight benefits decreasing the symptoms of URTIs | Very low quality of evidence, but it may be beneficial in adults (1b) | Insufficient data. No advice can be given about the use of nasal saline irrigation |
| Zinc | Acetate or gluconate ≥75 mg/day when taken within 24 h of onset of symptoms reduces the duration of common cold (1a) | No studies | No studies |
| Herbal medicines |
BNO1016, cineole and Andrographis paniculata SHA-10 extract have significant impact on symptoms of common cold without important adverse events (1b). Echinacea is not reccomended (1a -) |
In adults, BNO1016 tablets and Pelargonium sidoides drops and Myrtol (and other essential oil) capsules have significant impact on symptoms (1b) | Insufficient data |
BNO1016 (Sinupret) is an extract of five herbal drugs (gentian root, prímula flower, sorrel herb, elder flower, and verbena herb). 1a: Systematic review (with homogeneity) of RCTs. 1b: Individual RCT (with narrow confidence intervals)
URTI upper respiratory tract infection
aFrom the limited data available, it seems that especially beta-lactams (amoxicillin/penicillin) are effective and moxifloxacin (fluoroquinone) is not. The efficacy of beta-lactams is evident at day 3 where patients already experience better symptom improvement and continue with a higher number of cures at completion of treatmen
bIn ABRS, a short curse of oral corticosteroids (3–5 days) can be prescribed if severe unilateral pain is present
cSecond-generation antihistamines could be prescribed for the treatment of concomitant allergic rhinitis