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Giorgio Zanetti - One of the best experts on this subject based on the ideXlab platform.
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Acute Rhinosinusitis
PharmacoEconomics, 2004Co-Authors: Jean-blaise Wasserfallen, Françoise Livio, Giorgio ZanettiAbstract:Acute Rhinosinusitis is a common disease, in both children and adult patients, and happens most often in the setting of a viral infection with or without bacterial superinfection. Although spontaneous resolution is common, antibacterials are often prescribed and have a tremendous impact on costs, either directly or through the emergence of resistance in causative or colonising micro-organisms. The purpose of this work was to review published literature from 1989 to 2002 on antibacterial treatment in Acute Rhinosinusitis from a clinical and economical perspective. A relatively small number of studies have compared antibacterials with placebo and few have suggested that antibacterials are superior to placebo, except when a bacterial cause is established or in the presence of specific CT-scan findings. On the other hand, 58 randomised controlled trials were published between 1989 and 2002, that compared the relative efficacy of various antibacterials. Most of these studies had serious methodological flaws, and no single antibacterial proved superior to its comparators. Economic data are scarce and indicate cost of disease is high. Of the different treatment strategies assessed symptomatic treatment (patients being treated with antibacterials only if they failed to improve after 7 days) was the most cost-effective approach, compared with treating patients on the basis of specific clinical criteria, empirical treatment (all patients initially treated with antibacterials), or radiology-guided treatment. Cost effectiveness varied with disease prevalence. In conclusion, this pharmacoeconomic review of antibacterial use in Acute Rhinosinusitis shows the need for improvement in the quality of the studies feeding economic analyses, but suggests that huge financial interests are at stake. Savings achievable, by better targeting patients needing antibacterial treatment, could be substantial, and more practical and precise diagnostic procedures are clearly needed. Acute Rhinosinusitis is a typical example of a clinical dilemma in which good clinical practice must be balanced against imperfect information and patients’ individual interests balanced against society’s interest.
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Acute Rhinosinusitis : a pharmacoeconomic review of antibacterial use.
PharmacoEconomics, 2004Co-Authors: Jean-blaise Wasserfallen, Françoise Livio, Giorgio ZanettiAbstract:Acute Rhinosinusitis is a common disease, in both children and adult patients, and happens most often in the setting of a viral infection with or without bacterial superinfection. Although spontaneous resolution is common, antibacterials are often prescribed and have a tremendous impact on costs, either directly or through the emergence of resistance in causative or colonising micro-organisms. The purpose of this work was to review published literature from 1989 to 2002 on antibacterial treatment in Acute Rhinosinusitis from a clinical and economical perspective. A relatively small number of studies have compared antibacterials with placebo and few have suggested that antibacterials are superior to placebo, except when a bacterial cause is established or in the presence of specific CT-scan findings. On the other hand, 58 randomised controlled trials were published between 1989 and 2002, that compared the relative efficacy of various antibacterials. Most of these studies had serious methodological flaws, and no single antibacterial proved superior to its comparators. Economic data are scarce and indicate cost of disease is high. Of the different treatment strategies assessed symptomatic treatment (patients being treated with antibacterials only if they failed to improve after 7 days) was the most cost-effective approach, compared with treating patients on the basis of specific clinical criteria, empirical treatment (all patients initially treated with antibacterials), or radiology-guided treatment. Cost effectiveness varied with disease prevalence. In conclusion, this pharmacoeconomic review of antibacterial use in Acute Rhinosinusitis shows the need for improvement in the quality of the studies feeding economic analyses, but suggests that huge financial interests are at stake. Savings achievable, by better targeting patients needing antibacterial treatment, could be substantial, and more practical and precise diagnostic procedures are clearly needed. Acute Rhinosinusitis is a typical example of a clinical dilemma in which good clinical practice must be balanced against imperfect information and patients' individual interests balanced against society's interest.
Mieke L Van Driel - One of the best experts on this subject based on the ideXlab platform.
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Antibiotics for Acute Rhinosinusitis in adults
Cochrane Database of Systematic Reviews, 2018Co-Authors: Marieke B. Lemiengre, Mieke L Van Driel, Daniel Merenstein, Helena Liira, Marjukka Mäkelä, An De SutterAbstract:Background: Acute Rhinosinusitis is an Acute infection of the nasal passages and paranasal sinuses that lasts less than four weeks. Diagnosis of Acute Rhinosinusitis is generally based on clinical signs and symptoms in ambulatory care settings. Technical investigations are not routinely performed, nor are they recommended in most countries. Some trials show a trend in favour of antibiotics, but the balance of benefit versus harm is unclear. We merged two Cochrane Reviews for this update, which comprised different approaches with overlapping populations, resulting in different conclusions. For this review update, we maintained the distinction between populations diagnosed by clinical signs and symptoms, or imaging. Objectives: To assess the effects of antibiotics versus placebo or no treatment in adults with Acute Rhinosinusitis in ambulatory care settings. Search methods: We searched CENTRAL (2017, Issue 12), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (January 1950 to January 2018), Embase (January 1974 to January 2018), and two trials registers (January 2018). We also checked references from identified trials, systematic reviews, and relevant guidelines. Selection criteria: Randomised controlled trials of antibiotics versus placebo or no treatment in people with Rhinosinusitis-like signs or symptoms or sinusitis confirmed by imaging. Data collection and analysis: Two review authors independently extracted data about cure and side effects and assessed the risk of bias. We contacted trial authors for additional information as required. Main results: We included 15 trials involving 3057 participants. Of the 15 included trials, 10 appeared in our 2012 review, and five (631 participants) are legacy trials from merging two reviews. No new studies were included from searches for this update. Overall, risk of bias was low. Without antibiotics, 46% of participants with Rhinosinusitis, whether or not confirmed by radiography, were cured after 1 week and 64% after 14 days. Antibiotics can shorten time to cure, but only 5 to 11 more people per 100 will be cured faster if they receive antibiotics instead of placebo or no treatment: clinical diagnosis (odds ratio (OR) 1.25, 95% confidence interval (CI) 1.02 to 1.54; number needed to treat for an additional beneficial outcome (NNTB) 19, 95% CI 10 to 205; I; = 0%; 8 trials; high-quality evidence) and diagnosis confirmed by radiography (OR 1.57, 95% CI 1.03 to 2.39; NNTB 10, 95% CI 5 to 136; I; = 0%; 3 trials; moderate-quality evidence). Cure rates with antibiotics were higher when a fluid level or total opacification in any sinus was found on computed tomography (OR 4.89, 95% CI 1.75 to 13.72; NNTB 4, 95% CI 2 to 15; 1 trial; moderate-quality evidence). Purulent secretion resolved faster with antibiotics (OR 1.58, 95% CI 1.13 to 2.22; NNTB 10, 95% CI 6 to 35; I; = 0%; 3 trials; high-quality evidence). However, 13 more people experienced side effects with antibiotics compared to placebo or no treatment (OR 2.21, 95% CI 1.74 to 2.82; number needed to treat for an additional harmful outcome (NNTH) 8, 95% CI 6 to 12; I; = 16%; 10 trials; high-quality evidence). Five fewer people per 100 will experience clinical failure if they receive antibiotics instead of placebo or no treatment (Peto OR 0.48, 95% CI 0.36 to 0.63; NNTH 19, 95% CI 15 to 27; I; = 21%; 12 trials; high-quality evidence). A disease-related complication (brain abscess) occurred in one participant (of 3057) one week after receiving open antibiotic therapy (clinical failure, control group). Authors' conclusions: The potential benefit of antibiotics to treat Acute Rhinosinusitis diagnosed either clinically (low risk of bias, high-quality evidence) or confirmed by imaging (low to unclear risk of bias, moderate-quality evidence) is marginal and needs to be seen in the context of the risk of adverse effects. Considering antibiotic resistance, and the very low incidence of serious complications, we conclude there is no place for antibiotics for people with uncomplicated Acute Rhinosinusitis. We could not draw conclusions about children, people with suppressed immune systems, and those with severe sinusitis, because these populations were not included in the available trials.
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antibiotics for clinically diagnosed Acute Rhinosinusitis in adults
Cochrane Database of Systematic Reviews, 2012Co-Authors: Marieke B. Lemiengre, James B. Young, Mieke L Van Driel, Daniel Merenstein, An De SutterAbstract:In primary care settings, the diagnosis of Rhinosinusitis is generally based on clinical signs and symptoms. Technical investigations are not routinely performed, nor recommended. Individual trials show a trend in favour of antibiotics, but the balance of benefit versus harm is unclear. To assess the effect of antibiotics in adults with clinically diagnosed Rhinosinusitis in primary care settings. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2012), MEDLINE (January 1950 to February week 4, 2012) and EMBASE (January 1974 to February 2012). Randomised controlled trials (RCTs) of antibiotics versus placebo in participants with Rhinosinusitis-like signs or symptoms. Two authors independently extracted data and assessed the risk of bias. We contacted trial authors for additional information. We collected information on adverse effects from the trials. We included 10 trials involving 2450 participants. Overall, the risk of bias in these studies was low. Irrespective of the treatment group, 47% of participants were cured after one week and 71% after 14 days. Antibiotics can shorten the time to cure, but only five more participants per 100 will cure faster at any time point between 7 and 14 days if they receive antibiotics instead of placebo (number needed to treat to benefit (NNTB)) 18 (95% confidence interval (CI) 10 to 115, I(2) statistic 0%, eight trials). Purulent secretion resolves faster with antibiotics (odds ratio (OR) 1.58 (95% CI 1.13 to 2.22)), (NNTB 11, 95% CI 6 to 51, I(2) statistic 0%, three trials). However, 27% of the participants who received antibiotics and 15% of those who received placebo experienced adverse events (OR 2.10, 95% CI 1.60 to 2.77) (number needed to treat to harm (NNTH)) 8 (95% CI 6 to 13, I(2) statistic 13%, seven trials). More participants in the placebo group needed to start antibiotic therapy because of an abnormal course of Rhinosinusitis (OR 0.49, 95% CI 0.36 to 0.66), NNTH 20 (95% CI 14 to 35, I(2) statistic 0%, eight trials). Only one disease-related complication (brain abscess) occurred in a patient treated with antibiotics. The potential benefit of antibiotics in the treatment of clinically diagnosed Acute Rhinosinusitis needs to be seen in the context of a high prevalence of adverse events. Taking into account antibiotic resistance and the very low incidence of serious complications, we conclude that there is no place for antibiotics for the patient with clinically diagnosed, uncomplicated Acute Rhinosinusitis. This review cannot make recommendations for children, patients with a suppressed immune system and patients with severe disease, as these populations were not included in the available trials.
R.p. Venekamp - One of the best experts on this subject based on the ideXlab platform.
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Absence of evidence for enhanced benefit of antibiotic therapy on recurrent Acute Rhinosinusitis episodes: a systematic review of the evidence base
Otolaryngology–Head and Neck Surgery, 2013Co-Authors: Nina M. Kaper, R.p. Venekamp, Wilko Grolman, Laura Breukel, Geert J. M. G. Van Der HeijdenAbstract:ObjectiveTo systematically review the evidence base on the effectiveness of short-course antibiotic therapy in adult patients with a recurrent episode of Acute Rhinosinusitis as part of a disease pattern on severity and duration of symptoms and recurrences.Data SourcesPubMed, EMBASE, and the Cochrane Library.Review MethodsA comprehensive search was performed up to March 21, 2013. Articles reporting studies on the effects of short-course antibiotic therapy compared with placebo in patients with recurrent Acute Rhinosinusitis were included. For included articles, the design of reported studies was assessed for directness of evidence and risk of bias.ResultsIn total, 3473 unique publications were retrieved, of which 30 were considered eligible based on title and abstract screening. In addition, 8 eligible articles were retrieved using cross-reference checking. Based on full-text evaluation, none of the retrieved 38 articles satisfied our predefined selection criteria. They did not compare antibiotic treatmen...
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Limited Evidence for Effects of Intranasal Corticosteroids on Symptom Relief for Recurrent Acute Rhinosinusitis
Otolaryngology–Head and Neck Surgery, 2013Co-Authors: Juliette W. L. Van Loon, R.p. Venekamp, Alfred P. E. Sachs, Rochustina P. Van Harn, Nina M. Kaper, Geert J. M. G. Van Der HeijdenAbstract:Objective. To systematically review the evidence base on the effectiveness of intranasal corticosteroids in adult patients with recurrent Acute Rhinosinusitis. Data Sources. Pubmed, EMBASE, and the Cochrane Library. Review Methods. A comprehensive search was performed up to March 20, 2013. Two reviewers independently screened publications on title and abstract. Design of selected studies was assessed on directness of evidence and risk of bias. For included studies, risk differences with 95% confidence inter- vals were extracted or recalculated. Results. Of 1850 unique records, 3 trials were included. Risk of bias was high and directness of evidence was low for 2 tri- als, the third trial had low risk of bias with moderate direct- ness of evidence. They found a statistical significant difference for the median number of days to clinical success (defined as patients' report of symptoms to be cured or much improved) favoring intranasal corticosteroids (6 days) over placebo (9 days), while the difference in proportion of patients report- ing clinical success after 21 days of treatment was 20% favor- ing intranasal corticosteroids over placebo. Conclusion and Recommendation. The evidence for the benefit of intranasal corticosteroids on symptom relief in adult patients with recurrent Acute Rhinosinusitis is rather limited (ie, 3 trials are available; the best evidence is derived from 1 low risk of bias trial providing moderate directness of evidence that intranasal corticosteroids may speed up relief of symptoms in patients with recurrent Acute Rhinosinusitis). A large methodologically rigorous randomized trial in antibiotic-naive patients is needed to provide a more definite recommendation.
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Acute Rhinosinusitis and systemic corticosteroids
Canadian Medical Association Journal, 2013Co-Authors: R.p. VenekampAbstract:We sincerely thank Dr. Ukwaja[1][1] for his commentary on our CMAJ article.[2][2] To the best of our knowledge, no sign, symptom or test has been identified that can accurately differentiate viral from bacterial infection in patients with clinically diagnosed Acute Rhinosinusitis. Clinical practice
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Oral glucocorticoids for Acute Rhinosinusitis: an RCT
Nederlands Tijdschrift voor Geneeskunde, 2013Co-Authors: R.p. Venekamp, M.j.m. Bonten, Maroeska M. Rovers, Th J M Verheij, Alfred P. E. SachsAbstract:OBJECTIVE: To determine the efficacy of a short course of oral glucocorticoids in adult patients with Acute Rhinosinusitis. DESIGN: A double blind, placebo-controlled, randomized study conducted in 54 general practices in the Netherlands from December 2008 to March 2011 (NTR1295; http://www.trialregister.nl, search for 1295). METHOD: Adult patients with Acute Rhinosinusitis were randomly allocated to treatment with prednisolone 30 mg daily or placebo for 7 days. The primary outcome measure was the percentage of patients with resolution of facial pain or pressure on day 7. Secondary outcomes were time to recovery, median duration of symptoms, health-related quality of life, and reported side effects. RESULTS: 185 patients were randomized (prednisolone: n = 93; placebo: n = 92). Two participants withdrew from the study on day 1 and outcomes from 9 participants could not be included in the analysis because of incomplete data, leaving 174 patients (n = 88 and n = 86, respectively) eligible for intention-to-treat analyses. On day 7, 55/88 (62.5%) of patients in the prednisolone group and 48/86 (55.8%) in the placebo group had resolution of facial pain or pressure (difference: 6.7%; 95% CI: -7.9 to 21.2). There was no difference in the course of symptoms or health-related quality of life between groups. Side effects reported were mild and did not differ between groups. CONCLUSION: A short course of oral glucocorticoids seemed to have no clinically relevant beneficial effects in adult patients with Acute Rhinosinusitis.
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Systemic corticosteroid monotherapy for clinically diagnosed Acute Rhinosinusitis: a randomized controlled trial
Canadian Medical Association Journal, 2012Co-Authors: R.p. Venekamp, M.j.m. Bonten, Maroeska M. Rovers, Th J M Verheij, Alfred P. E. SachsAbstract:Background: Patients with Acute Rhinosinusitis are frequently encountered in primary care. Although corticosteroids are being increasingly used for symptom control, evidence supporting their use is inconclusive. We conducted a randomized controlled trial to examine the effectiveness of systemic corticosteroid monotherapy for clinically diagnosed, uncomplicated Acute Rhinosinusitis. Methods: We conducted a block-randomized, double-blind, placebo-controlled clinical trial at 54 primary care practices (68 family physicians) in the Netherlands between Dec. 30, 2008, and Apr. 28, 2011. Adult patients with clinically diagnosed Acute Rhinosinusitis were randomly assigned to receive either prednisolone 30 mg/d or placebo for 7 days and asked to complete a symptom diary for 14 days. The primary outcome measure was the proportion of patients with resolution of facial pain or pressure on day 7. Results: Of the 185 patients included in the trial (93 in the treatment group, 92 in the placebo group), 2 withdrew from the study and 9 were excluded from the primary analysis because of incomplete symptom reporting. The remaining 174 patients (88 in the treatment group, 86 in the placebo group) were included in the intention-to-treat analysis. The proportions of patients with resolution of facial pain or pressure on day 7 were 62.5% (55/88) in the prednisolone group and 55.8% (48/86) in the placebo group (absolute risk difference 6.7%, 95% confidence interval −7.9% to 21.2%). The groups were similar with regard to the decrease over time in the proportion of patients with total symptoms (combined symptoms of runny nose, postnasal discharge, nasal congestion, cough and facial pain) and health-related quality of life. Adverse events were mild and did not differ significantly between the groups. Interpretation: Systemic corticosteroid monotherapy had no clinically relevant beneficial effects among patients with clinically diagnosed Acute Rhinosinusitis. Netherlands Trial Register registration no. 1295 (www.trialregister.nl/trialreg/index.asp).
Christian Schindler - One of the best experts on this subject based on the ideXlab platform.
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Effect of Amoxicillin-Clavulanate in Clinically Diagnosed Acute Rhinosinusitis
2017Co-Authors: Heiner C. Bucher, Peter Tschudi, James B. Young, Christian SchindlerAbstract:Background: Acute Rhinosinusitis is one of the most common reasons for prescribing antibiotics in primary care. However, it is not clear whether antibiotics improve the outcome for patients with clinically diagnosed Acute Rhinosinusitis. We evaluated the effect of a combination product of amoxicillin–potassium clavulanate on adults with Acute Rhinosinusitis that was clinically diagnosed in a general practice setting. Methods: We conducted a randomized, placebocontrolled, double-blind trial with 252 adults recruited at 24 general practices and 2 outpatient clinics. Each patient had a history of purulent nasal discharge and maxillary or frontal pain for at least 48 hours. Patients were given amoxicillin, 875 mg, and clavulanic acid, 125 mg, or placebo twice daily for 6 days. Main outcome measures were time to cure (primary outcome), number of days during which Rhinosinusitis restricted activities at home or work, and frequency of adverse effects (secondary outcomes). Results: The adjusted hazard ratio for the effect of amoxicillin-clavulanate was 0.99 (95% confidence interval [CI], 0.68-1.45) on time to cure and 1.28 (95% CI, 0.80-2.05) in the prespecified subgroup of patients with a positive rhinoscopy result. At 7 days the mean difference between amoxicillin-clavulanate and placebo was �0.29 (95% CI, �0.93 to 0.34) in the number of days with restrictions due to Rhinosinusitis and �0.60 (95% CI, �1.41 to 0.21) in patients with a positive rhinoscopy result. At 7 days patients who took amoxicillin-clavulanate were more likely to have diarrhea (odds ratio, 3.89; 95% CI, 2.09-7.25). Conclusions: Adult patients in general practice with clinically diagnosed Acute Rhinosinusitis experience no advantage with antibiotic treatment with amoxicillinclavulanate and are more likely to experience adverse effects.
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effect of amoxicillin clavulanate in clinically diagnosed Acute Rhinosinusitis a placebo controlled double blind randomized trial in general practice
JAMA Internal Medicine, 2003Co-Authors: Heiner C. Bucher, Peter Tschudi, Jim Young, Pierre Periat, Antje Welgelussen, Hansjorg Zust, Christian SchindlerAbstract:Background Acute Rhinosinusitis is one of the most common reasons for prescribing antibiotics in primary care. However, it is not clear whether antibiotics improve the outcome for patients with clinically diagnosed Acute Rhinosinusitis. We evaluated the effect of a combination product of amoxicillin–potassium clavulanate on adults with Acute Rhinosinusitis that was clinically diagnosed in a general practice setting. Methods We conducted a randomized, placebo-controlled, double-blind trial with 252 adults recruited at 24 general practices and 2 outpatient clinics. Each patient had a history of purulent nasal discharge and maxillary or frontal pain for at least 48 hours. Patients were given amoxicillin, 875 mg, and clavulanic acid, 125 mg, or placebo twice daily for 6 days. Main outcome measures were time to cure (primary outcome), number of days during which Rhinosinusitis restricted activities at home or work, and frequency of adverse effects (secondary outcomes). Results The adjusted hazard ratio for the effect of amoxicillin-clavulanate was 0.99 (95% confidence interval [CI], 0.68-1.45) on time to cure and 1.28 (95% CI, 0.80-2.05) in the prespecified subgroup of patients with a positive rhinoscopy result. At 7 days the mean difference between amoxicillin-clavulanate and placebo was −0.29 (95% CI, −0.93 to 0.34) in the number of days with restrictions due to Rhinosinusitis and −0.60 (95% CI, −1.41 to 0.21) in patients with a positive rhinoscopy result. At 7 days patients who took amoxicillin-clavulanate were more likely to have diarrhea (odds ratio, 3.89; 95% CI, 2.09-7.25). Conclusions Adult patients in general practice with clinically diagnosed Acute Rhinosinusitis experience no advantage with antibiotic treatment with amoxicillin-clavulanate and are more likely to experience adverse effects.
Miriam Chan - One of the best experts on this subject based on the ideXlab platform.
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Current Concepts in Adult Acute Rhinosinusitis.
American family physician, 2016Co-Authors: Ann M. Aring, Miriam ChanAbstract:Acute Rhinosinusitis is one of the most common conditions that physicians treat in ambulatory care. Most cases of Acute Rhinosinusitis are caused by viral upper respiratory infections. A meta-analysis based on individual patient data found that common clinical signs and symptoms were not effective for identifying patients with Rhinosinusitis who would benefit from antibiotics. C-reactive protein and erythrocyte sedimentation rate are somewhat useful tests for confirming Acute bacterial maxillary sinusitis. Four signs and symptoms that significantly increase the likelihood of a bacterial cause when present are double sickening, purulent rhinorrhea, erythrocyte sedimentation rate greater than 10 mm per hour, and purulent secretion in the nasal cavity. Although cutoffs vary depending on the guideline, antibiotic therapy should be considered when Rhinosinusitis symptoms fail to improve within seven to 10 days or if they worsen at any time. First-line antibiotics include amoxicillin with or without clavulanate. Current guidelines support watchful waiting within the first seven to 10 days after upper respiratory symptoms first appear. Evidence on the use of analgesics, intranasal corticosteroids, and saline nasal irrigation for the treatment of Acute Rhinosinusitis is poor. Nonetheless, these therapies may be used to treat symptoms within the first 10 days of upper respiratory infection. Radiography is not recommended in the evaluation of uncomplicated Acute Rhinosinusitis. For patients who do not respond to treatment, computed tomography of the sinuses without contrast media is helpful to evaluate for possible complications or anatomic abnormalities. Referral to an otolaryngologist is indicated when symptoms persist after maximal medical therapy and if any rare complications are suspected.
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Acute Rhinosinusitis in adults.
American family physician, 2011Co-Authors: Ann M. Aring, Miriam ChanAbstract:Rhinosinusitis is one of the most common conditions for which patients seek medical care. Subtypes of Rhinosinusitis include Acute, subAcute, recurrent Acute, and chronic. Acute Rhinosinusitis is further specified as bacterial or viral. Most cases of Acute Rhinosinusitis are caused by viral infections associated with the common cold. Symptomatic treatment with analgesics, decongestants, and saline nasal irrigation is appropriate in patients who present with nonsevere symptoms (e.g., mild pain, temperature less than 101°F [38.3°C]). Narrow-spectrum antibiotics, such as amoxicillin or trimethoprim/sulfamethoxazole, are recommended in patients with symptoms or signs of Acute Rhinosinusitis that do not improve after seven days, or that worsen at any time. Limited evidence supports the use of intranasal corticosteroids in patients with Acute Rhinosinusitis. Radiographic imaging is not recommended in the evaluation of uncomplicated Acute Rhinosinusitis. Computed tomography of the sinuses should not be used for routine evaluation, although it may be used to define anatomic abnormalities and evaluate patients with sus- pected complications of Acute bacterial Rhinosinusitis. Rare complications of Acute bacterial Rhinosinusitis include orbital, intracranial, and bony involvement. If symptoms persist or progress after maximal medical therapy, and if computed tomography shows evidence of sinus disease, referral to an otolaryngologist is warranted.
