Watchful waiting extended as initial management strategy for all patients with uncomplicated acute bacterial rhinosinusitis
By Elana Gotkine HealthDay Reporter
WEDNESDAY, Aug. 6, 2025 (HealthDay News) — In a clinical practice guideline update issued by the American Academy of Otolaryngology-Head and Neck Surgery Foundation and published in the August issue of Otolaryngology-Head and Neck Surgery, new recommendations are presented for the diagnosis and management of adult rhinosinusitis.
Spencer C. Payne, M.D., from the University of Virginia in Charlottesville, and colleagues updated the guidelines published in 2015 to address quality improvement opportunities for managing adult sinusitis. New evidence was considered from 14 guidelines, 194 systematic reviews, and 133 randomized controlled trials.
The authors emphasize patient education and counseling. Watchful waiting has been extended as an initial management strategy to include all patients with uncomplicated acute bacterial rhinosinusitis (ABRS), regardless of severity, and not just to patients with mild illness, as seen in the previous guideline. The recommended timeline for diagnosis, conservative management, and antibiotic treatment of ABRS is clarified. Recommended first-line antibiotic therapy for ABRS has been changed to amoxicillin with or without clavulanate from amoxicillin alone. Aspirin-exacerbated respiratory disease is added as a chronic condition that modifies management of chronic rhinosinusitis (CRS). Three new key action statements are presented for managing CRS: The guideline recommends against the use of biologics when patients do not have nasal polyps; when patients do have nasal polyps, the guideline recommends that they are educated about biologics; and the guideline recommends against antibiotic use for CRS only as a third-party requirement for surgery or imaging.
“With sinusitis affecting about one in eight adults in the United States each year, this clinical practice guideline update empowers both patients and their health care providers with evidence-based recommendations that can lead to better outcomes,” Payne said in a statement.
Several authors disclosed ties to the biopharmaceutical and medical device industries.
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