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Viral rhinosinusitis — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareViral rhinosinusitisUSMLE Step 3

A 68-year-old has 11 days of purulent nasal drainage, maxillary pain, and cough without improvement. He took amoxicillin 3 weeks ago, has no drug allergy, and lives where penicillin-nonsusceptible pneumococci are common. Which initial oral regimen is most appropriate?

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Correct answer: C — High-dose amoxicillin-clavulanate 2 g/125 mg extended release orally twice daily

The best answer is “High-dose amoxicillin-clavulanate 2 g/125 mg extended release orally twice daily”. Persistent symptoms establish acute bacterial rhinosinusitis, while age over 65, antibiotic exposure within the previous month, and high local penicillin-nonsusceptible pneumococcal prevalence favor the high-dose regimen. Doxycycline or a respiratory fluoroquinolone may be alternatives in selected adults with beta-lactam allergy but are not preferred here.

Reference: IDSA Clinical Practice Guideline: Acute Bacterial Rhinosinusitis: https://www.idsociety.org/practice-guideline/rhinosinusitis/