Guideline sources The following summarized guidelines for the evaluation and management of acute viral rhinosinusitis (AVRS) are prepared by our editorial team based on guidelines from the American College of Physicians (ACP/CDC 2016), the Infectious Diseases Society of America (IDSA 2015), and the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2015). 1 2 3 4 4 5 5 Definition AVRS or the common cold is the sudden onset of two or more symptoms, one of which should be either nasal blockage/obstruction/congestion or nasal discharge for less than 12 weeks caused by a viral etiology. 4 Epidemiology AVRS is mostly caused by RSV (RSV), rhinovirus, parainfluenza, and influenza with rhinovirus. 4 Disease course The inflammation and injury of nasal respiratory epithelium and mucosa by viruses results in AVRS, which causes clinical manifestations of rhinorrhea, nasal blockage, sneezing, watery eyes, nasal and ocular pruritus, chills, and muscle aches. The symptoms usually resolve within 4-10 days of a self-limiting course. 5 Prognosis and risk of recurrence https://web.pathway.md/diseases/recZxjK1hg556UCye 1/3 6/23/23, 2:08 AM Acute viral rhinosinusitis Pathway AVRS is not associated with an increase in mortality. 5 Guidelines 1. Screening and diagnosis Differential diagnosis: distinguish presumed AVRS from acute bacterial rhinosinusitis, and from acute rhinosinusitis caused by noninfectious conditions. B 2. Diagnostic investigations Diagnostic imaging: avoid radiographic imaging for patients who meet diagnostic criteria for AVRS, unless a complication or an alternative diagnosis is suspected. D 3. Medical management Antibiotic therapy: As per ACP 2016 guidelines, reserve antibiotic treatment for acute rhinosinusitis in patients with persistent symptoms for > 10 days, onset of severe symptoms or signs of high fever (> 39 C) and purulent nasal discharge or facial pain lasting 3 consecutive days, or onset of worsening symptoms following a typical viral illness lasted 5 days that was initially improving (double sickening). B As per Choosing Wisely 2015 guidelines, avoid using antibiotics in patients with AVRS as antibiotic treatment is ineffective, inappropriate, and potentially harmful. D Symptomatic treatment: consider advising analgesics, topical intranasal steroids, and/or intranasal saline irrigation for symptomatic relief in patients with AVRS. C References 1. Infectious Diseases Society of America. Choosing Wisely: Recommendations of the Infectious Diseases Society of America. Choosing Wisely. 2015 Feb. Open 2. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015 Apr;152 2 Suppl):S1 S39. Open 3. Aaron M Harris, Lauri A Hicks, Amir Qaseem et al. Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016 Mar 15;164 6 425 34. Open 4. Neil Foden, Christopher Burgess, Kathryn Shepherd et al. A guide to the management of acute rhinosinusitis in primary care: management strategy based on best evidence and recent European guidelines. 2013 Nov;63 616 611 3.2013 Nov;63 616 611 3. Open https://web.pathway.md/diseases/recZxjK1hg556UCye 2/3 6/23/23, 2:08 AM Acute viral rhinosinusitis Pathway 5. Anthony W Chow, Michael S Benninger, Itzhak Brook et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. 2012 Apr;54 8):e72-e112.2012 Apr;54 8):e72-e112. Open 6. Wald ER, Applegate KE, Bordley C et al. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013 Jul;132 1):e262 80. Open 7. American Academy of Pediatrics. Choosing Wisely AAP recommendations. Choosing Wisely. 2018. Open https://web.pathway.md/diseases/recZxjK1hg556UCye 3/3