Acute sinusitis - Principles of judicious use of antimicrobial agents

Establishing an accurate diagnosis of bacterial sinusitis is challenging but critical because viral rhinosinusitis is at least 20 to 200 times more common than bacterial infection of the sinuses. Strict criteria for clinical diagnosis that require either prolonged and persistent symptoms or an acute severe presentation are supported with published evidence. Radiographic imaging of the sinuses should be used only in very selected circumstances. A majority of patients with the common cold will meet radiographic criteria for sinusitis early in the course of their illness. For patients meeting these strict criteria, an appropriate narrow-spectrum antimicrobial agent will be of modest benefit compared with symptomatic treatment alone.