Acute Bacterial Rhinosinusitis Causes, Signs, Symptoms, Diagnosis, Treatment

Acute Bacterial Rhinosinusitis Causes, Symptoms, Diagnosis, Treatment

What is acute bacterial rhinosinusitis?

Acute bacterial rhinosinusitis (ABRS) is caused by a bacterial infection of the paranasal sinuses. Symptoms include facial pain and pressure, purulent drainage, congestion and fever.

The most common bacteria associated with ABRS include Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Almost all cases of acute bacterial rhinosinusitis are preceded by an acute viral rhinitis (or common cold).

In the most common presentation, symptoms of a common cold develop and will resolve over the course of seven to 10 days. In approximately two to five percent of cases, however, acute bacterial rhinosinusitis develops. When this happens, the cold symptoms get worse or do not start to resolve after five to seven days. At this point, it is appropriate to start antibiotic therapy.

On the other hand, starting antibiotics earlier is not recommended, because the condition is probably viral. Antibiotics do nothing for viral rhinitis and the condition will usually resolve without specific treatment.

What are the signs and symptoms of acute bacterial rhinosinusitis?

Your signs and symptoms may be worse when you lie on your back or try to sleep. You may have any of the following:

  • Stuffy nose and reduced sense of smell
  • Runny nose with thick yellow or green mucus
  • Pressure or pain on your face and a headache
  • Pain in your teeth and bad breath
  • Ear pain or pressure
  • Fever
  • Cough
  • Tiredness

When should I seek immediate care?

  • Your eye and eyelid are red, swollen, and painful.
  • You cannot open your eye.
  • You have double vision or you cannot see.
  • Your eyeball bulges out or you cannot move your eye.
  • You are more sleepy than normal or you notice changes in your ability to think, move, or talk.
  • You have a stiff neck, a fever, or a bad headache.
  • You have swelling of your forehead or scalp.

How is acute bacterial rhinosinusitis diagnosed?

Your caregiver will feel your sinuses and look in your eyes, nose, mouth, and ears. He will ask you to describe your symptoms and how long you have had them. Tell him if your symptoms have gotten better or worse since they began. You may have ABRS if your symptoms have gotten worse after 5 to 7 days or lasted longer than 10 days. You may need the following tests:

  • Culture: Your caregiver may take a mucus sample from your nose and test it for bacteria.
  • X-ray or CT scan: Rarely, an x-ray or CT scan may be needed to check for problems or abnormal areas in your sinuses.

Acute Bacterial Rhinosinusitis treatment

Most patients with acute bacterial rhinosinusitis improve without antibiotic treatment.

About 81% of antibiotic-treated patients and 66% of controls are improved at 10-14 days (absolute benefit of 15%).

Patients with mild symptoms should not receive antibiotics, but symptomatic treatment may be helpful.

  • Topical and oral decongestants may reduce nasal symptoms.
  • Most randomized trials of symptomatic therapies have been inconclusive.

Patients with moderate or severe symptoms may benefit from antibiotics.

Which medicines are used to treat acute bacterial rhinosinusitis?


This will help you fight or prevent an infection. Take your antibiotics until they are gone, even if you feel better sooner.


This helps reduce swelling and drain mucus in the nose and sinuses. Decongestants may help you breathe normally.


This helps dry mucus in the nose and relieve sneezing.


These medicines help lower a fever or decrease pain. This medicine can be bought without a doctor's order. Always read the medicine label and follow the directions. NSAIDs can cause stomach bleeding or kidney problems if they are not taken correctly.


This helps reduce fever and pain. You can buy acetaminophen without a doctor's order.

How can I care for myself when I have acute bacterial rhinosinusitis?

Rinse your sinuses: Use a sinus rinse device to rinse your nasal passages with saline (salt water) solution. This will help thin the mucus in your nose and rinse away pollen and dirt. It will also help reduce swelling so you can breathe normally. Ask your caregiver how often to do this.

Breathe steam: Heat a bowl of water until you see steam. Make a tent over your head with a large towel. Hold your face over the steam and breathe deeply for about 20 minutes. Be careful not to get too close to the steam or burn yourself. Do this 3 times a day. Also breathe deeply when you take a hot shower.

Sleep with your head elevated: Place an extra pillow under your head before you go to sleep to help your sinuses drain.

Drink extra liquids: Liquids will thin the mucus in your nose and help it drain. Avoid drinks that contain alcohol or caffeine.

Do not smoke or go to smoky places: Smoke will worsen your symptoms.

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