What are the recommended first-line treatments for acute rhinosinusitis in adults?

First-line treatment for acute rhinosinusitis in adults primarily involves symptomatic management rather than immediate antibiotic therapy. Initial management includes analgesics such as paracetamol or NSAIDs to relieve pain and fever, and nasal decongestants or saline nasal sprays to improve nasal airflow and drainage. Antibiotics are generally not recommended at first presentation unless symptoms are severe, worsening, or persistent beyond 10 days, indicating a likely bacterial infection. When antibiotics are indicated, amoxicillin is typically the first-line choice due to its efficacy against common bacterial pathogens involved in acute rhinosinusitis. This approach aligns with UK clinical guidelines emphasising cautious antibiotic use to reduce resistance and adverse effects. Additionally, supportive care with adequate hydration and rest is advised. The literature supports this conservative approach, highlighting that most cases are viral and self-limiting, and that antibiotics provide only modest benefit in selected bacterial cases Grevers & Klemens 2002.