Acute sinusitis in daily clinical practice

Understanding the appropriate use of diagnostics and treatment in acute rhinosinusitis is of immense importance given the high prevalence of this disease in the general population. The ability to differentiate between the principal phenotypes of acute sinusitis, namely acute viral infection (cold), acute post-viral sinusitis and acute bacterial sinusitis, determines the future management and is fundamental to providing rational therapeutic recommendations - especially as regards antibiotic treatment, which is very often overused in acute sinusitis even though bacterial phenotypes only account for 0.5-2% of all cases of the disease. The latest therapeutic recommendations contained in the EPOS2020 position paper introduce a system based on integrated care pathways (ICPs), which comprise pharmacy-supported self-care and e-health as the first level, followed by primary care as the second, with specialist care being reserved for patients who develop a more severe course of the disease, have suspected complications or suffer from recurrent acute sinusitis. Management of acute sinusitis is primarily based on symptomatic treatment modalities, with phytotherapeutic support, as well as on antiinflammatory treatment, while antibiotic therapy is used in very specific and limited indications. Complications are relatively rare in acute sinusitis and they are not considered to be associated with antibiotic intake. Considering the high prevalence of acute forms of sinusitis, their significant impact on quality of life and high direct and indirect costs of treatment, the right diagnosis and management, without unnecessary escalation of therapy, can substantially translate into a number of public health benefits.