Identifying viral vs. bacterial sinusitis

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Identifying viral vs. bacterial sinusitis
Identifying viral vs. bacterial sinusitis

Although the vast majority of sinus infections are caused by viruses, bacteria are likely to be the culprits in specific circumstances, and in those instances, antibiotics should be used.


This information comes from a new guideline issued by the Infectious Diseases Society of America (IDSA) focusing on acute bacterial rhinosinusitis in children and adults. Authored by a team led by Anthony W. Chow, MD, the guideline is available, on the IDSA website and provides specific characteristics of the illness to help distinguish between viral and bacterial sinus infections.


According to the guideline, a sinus infection is likely to be caused by bacteria rather than a virus if any of the three following conditions is present:

  1. Symptoms last for at least 10 days without any evidence of clinical improvement
  2. Symptoms are severe, including fever of 102°F or higher, and nasal discharge and facial pain enduring for at least three to four consecutive days at the beginning of illness
  3. Symptoms or signs worsen, as characterized by new fever or headache developing or nasal discharge increasing, typically after a viral upper respiratory infection that lasted five or six days and initially seemed to improve.


The IDSA guideline also suggests that a five- to seven-day course of antibiotics is long enough to treat the infection in adults without encouraging antibiotic resistance. Children, however, should undergo antibiotic treatment for 10 to 14 days.


Topical and oral decongestants and antihistamines should be avoided in patients with acute bacterial rhinosinusitis due to scant evidence that they hasten recovery; they may even induce inflammation in the nasal cavity, according to the guideline. Symptoms should be managed by means of hydration, analgesics, antipyretics, saline irrigation and intranasal corticosteroids. 


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