# *** (Acute/Chronic) Rhinosinusitis
-- Onset: *** (acute <1mo, chronic >3m)
-- Symptoms: *** (fevers, rhinorrhea, unilateral purulence, facial pressure/pain, cough, HA, anosmia, ear fullness)
-- Initial Improvement?: ***
-- Risk Factors For Resistance: *** (age 65+, comorbidity, high fevers, immunosuppressed, or recent hospitalization or abx use)
-- Number of Annual Episodes: *** (4 or more is considered recurrent)
-- Red Flags: *** (fevers >102; severe HA, AMS, eye pain, swelling, impaired vision, double vision, skin discoloration suggesting necrosis)
-- Abx: *** if indicated (>10 days without impovement, fever to 102 for 3 days, worsening symptoms after initial improvement) give augmentin 875/125mg q12 for 5-7 days or 2g q12 if RF for resistance; doxy 875mg BID if PCN allergy
-- Fever/Pain: *** Tylenol 325-1000mg q6 for pain;
-- Congestion: saline irrigation, fluticasone nasal spray PRN, pseudoephedrine 30mg q6 PRN; oxymetolazone spray 2-3 sprays per nostril twice daily for max 3 days (avoid in HTN)
-- Avoid steroids and anithistamines
-- Smoking cessation
-- CT of the sinuses if recurrent disease, concern for red flags, or concern for fungal involvement
Template PDF coming soon!
It sounds like you are having an episode of acute sinusitis. Based on your history and symptoms, we are *** concerned there may be a bacterial infection.
We recommend treating with *** augmentin twice daily for *** 7 days.
You can also take tylenol or ibuprofen for pain, saline irrigation, fluticasone nasal spray, and pseudoephedrine for congestion.
We can plan to re-assess your symptoms in 3 days.
Few sinusitis infections are caused by bacteria and benefit from antibiotics. Treat with augmentin if the symptoms have been present for greater than 10 days without impovement, they have had a fever to 102 for 3 days, or there are worsening symptoms after initial improvement. Otherwise, treat supportively.