Guideline Video

Guideline Resources

  • Title: Complicated Urinary Tract Infection (cUTI) Guideline on Treatment and Management
  • Society: American Academy of Otolaryngology- Head and Neck Surgery Foundation (AAO-HNS)
  • Publish Date: June 31, 2025
  • Overview
  • Pocket Guide (Premium)
  • Full-text

Video Transcription

Today we’ll be going over The American Academy of Otolaryngology- Head and Neck Surgery Foundation’s newest guideline on Adult Sinusitis.

The objective of this guidelines is to address diagnostic accuracy for adult rhinosinusitis, the appropriate use of ancillary tests to confirm diagnosis and guide management (including radiography, nasal endoscopy, computed tomography, and testing for allergy and immune function), and the judicious use of systemic and topical therapy.

There are 14 key action statements, so let’s get started

  • Clinicians should distinguish presumed acute bacterial rhinosinusitis (ABRS) from acute

rhinosinusitis caused by viral upper respiratory infections and noninfectious conditions. A

clinician should diagnose ABRS when (a) symptoms or signs of acute rhinosinusitis

persist without evidence of improvement for at least 10 days beyond the onset of upper respiratory symptoms, or (b) symptoms or signs of acute rhinosinusitis worsen within 10 days after an initial improvement.

  • Clinicians should not obtain radiologic imaging for patients who meet diagnostic criteria for acute rhinosinusitis unless a complication or alternative diagnosis is suspected
  • Clinicians may recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation for symptomatic relief of viral rhinosinusitis (VRS)
  • Clinicians may recommend analgesics, topical intranasal steroids, and/or nasal saline irrigation for symptomatic relief of ABRS.
  • Clinicians should offer watchful waiting (without antibiotics) for adults with uncomplicated ABRS with assurance of follow-up. The duration of watchful waiting may depend on the factors and timing under which the diagnosis was originally made.
  • If a decision is made to treat ABRS with an antibiotic agent, the clinician should prescribe amoxicillin with or without clavulanate as first-line therapy for 5-7 days for most adults.
  • If the patient fails to improve or worsens despite being on an appropriate antibiotic for 3-5 days, the clinician should reassess the patient to confirm ABRS, exclude other causes of illness, and detect complications. If ABRS is confirmed, the clinician should change the antibiotic.
  • Clinicians should distinguish CRS and RARS from isolated episodes of acute bacterial rhinosinusitis and other causes of sinonasal symptoms.
    • The clinician should confirm a clinical diagnosis of CRS with objective documentation of sinonasal inflammation, which may be accomplished using anterior rhinoscopy, nasal endoscopy, or computed tomography
  • Clinicians should assess the patient with chronic rhinosinusitis or recurrent acute rhinosinusitis for multiple chronic conditions that would modify management such as asthma, cystic fibrosis, immunocompromised state, aspirin-exacerbated respiratory disease, and ciliary dyskinesia
  • The clinician may obtain testing for allergy and immune function in evaluating a patient with chronic rhinosinusitis or recurrent acute rhinosinusitis
  • The clinician should confirm the presence or absence of nasal polyps in a patient with CRS
  • Clinicians should recommend saline nasal irrigation, topical intranasal corticosteroids, or both for symptom relief of CRS.
  • Clinicians should not prescribe topical or systemic antifungal therapy for patients with CRS
  • Clinicians should not routinely prescribe biologics (including, but not limited to, monoclonal antibodies such as dupilumab, mepolizumab, or omalizumab) for the treatment of adults with CRS without polyps
    • Clinicians or their designee should educate patients with CRS and nasal polyps about the role of biologics as a means to improve disease-specific quality of life when either prior medical and surgical therapy has failed OR when surgery is not a viable option because of disease status or patient preference.
  • Clinicians should not routinely prescribe antimicrobial therapy for adults with CRS without acute exacerbation OR as a mandatory prerequisite for paranasal sinus imaging or surgery

And there you have it. Make sure to check out the full guideline from The American Academy of Otolaryngology- Head and Neck Surgery Foundation and other related clinical decision support tools at guidelinecentral.com.

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