Chronic and recurrent sinusitis treatment principles
Functional endoscopic sinus surgery when medical therapy fails
Improves ostial patency and mucociliary clearance
Biologics for chronic rhinosinusitis with nasal polyps
Dupilumab — anti-IL-4 and IL-13 receptor antagonist
Mepolizumab — anti-IL-5 for severe eosinophilic CRS
Allergen immunotherapy for allergic rhinitis-associated sinusitis
Aspirin desensitization for AERD after surgical intervention
Patient Discharge Instructions
copy discharge instructions
Sinusitis home care instructions
Most sinus infections are caused by viruses and get better in 7 to 10 days without antibiotics
Rest and drink plenty of fluids to thin secretions
Use nasal saline rinses 2 times a day — these help clear mucus and reduce symptoms
Intranasal steroid spray as prescribed — use it as directed even if symptoms improve
Acetaminophen or ibuprofen for pain or fever as directed on the label
Oxymetazoline nasal spray — do not use for more than 5 days
If prescribed antibiotics
Take antibiotics exactly as prescribed for the full course
Do not stop early even if you feel better
Common side effects include diarrhea, nausea, or rash — contact your doctor if severe
Diarrhea with blood or mucus — stop antibiotics and seek medical care
Return to the emergency department immediately for
Swelling or redness around your eye
Eye pain or difficulty moving your eye
Vision changes or blurry vision
Severe or worsening headache not relieved by pain medicine
Confusion, difficulty thinking clearly, or unusual drowsiness
Stiff neck
Swelling on your forehead
Fever that does not improve despite medication
Symptoms getting significantly worse after initially improving
Follow-up guidance
If on watchful waiting without antibiotics — return to your doctor in 7 days if symptoms are not improving
If on antibiotics — contact your doctor in 3 to 5 days if you are not improving
If symptoms last more than 12 weeks — evaluation for chronic sinusitis is needed
Avoid smoking and secondhand smoke — these worsen sinus infections
Expected recovery — symptoms usually begin improving in 7 to 10 days and full recovery may take 2 to 3 weeks
References
Guidelines and key sources
Primary guidelines
AAO-HNS Clinical Practice Guideline Adult Sinusitis Update 2025 — Payne SC, McKenna M, Buckley J et al, Otolaryngology-Head and Neck Surgery 2025
Endorses watchful waiting for all uncomplicated ABRS
Updated criteria for surgery, biologics, and chronic rhinosinusitis
IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults 2012
Three temporal diagnostic criteria for ABRS
Amoxicillin as first-line; amoxicillin-clavulanate for resistance risk
AAP Clinical Practice Guideline for Acute Bacterial Sinusitis in Children 1 to 18 Years — Wald ER et al, Pediatrics 2013
Pediatric-specific antibiotic dosing and criteria
Evidence reviews and society statements
Evidence summaries
Acute Rhinosinusitis Rapid Evidence Review — Butler FM, Hernandez DR, American Family Physician 2025
NNT and NNH data for antibiotics versus placebo
Diagnostic pattern review and antibiotic stewardship evidence
Acute Sinusitis in Adults — Rosenfeld RM, New England Journal of Medicine 2016
Comprehensive review of diagnosis and treatment evidence
Watchful waiting safety-net prescription approach
Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults — Harris AM, Hicks LA, Qaseem A, Annals of Internal Medicine 2016
American College of Physicians and CDC joint guidance on antibiotic stewardship
Current Concepts in Adult Acute Rhinosinusitis — Aring AM, Chan MM, American Family Physician 2016
Pathogen distribution and resistance pattern data
Coding reference
Diagnostic coding
ICD-10 J01.90 acute sinusitis unspecified
J01.00 acute maxillary sinusitis unspecified
J01.10 acute frontal sinusitis unspecified
J01.20 acute ethmoidal sinusitis unspecified
J01.30 acute sphenoidal sinusitis unspecified
ICD-10 J32.9 chronic sinusitis unspecified
SNOMED CT 36971009 sinusitis
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.