acute sinusitis met koorts en etterslijmen, welke keuze antibiotica en welke

Antibiotic Treatment: For a patient presenting with acute bacterial sinusitis characterized by fever greater than 38°C and purulent nasal discharge, antibiotic therapy should be considered, especially when there are at least three indicative features such as persistent symptoms beyond 10 days, severe localized pain, and clinical deterioration after an initial milder phase NICE CKS Hickner et al. 2001. The first-line antibiotic recommended is a narrow-spectrum agent active against common pathogens like Streptococcus pneumoniae and Haemophilus influenzae, such as phenoxymethylpenicillin, or amoxicillin-clavulanate in cases where beta-lactamase-producing organisms are suspected or clinical severity warrants broad coverage NICE CKS Hickner et al. 2001 Christensen et al. 2026. Antibiotic use is not routinely required in uncomplicated sinusitis cases, as the majority resolve spontaneously and indiscriminate prescribing contributes to antimicrobial resistance NICE CKS NICE NG63 Hickner et al. 2001. In cases with severe symptoms or systemic involvement, adherence to antibiotic stewardship principles is essential to optimize treatment while minimizing resistance emergence NICE NG63 Christensen et al. 2026.

Adjuvant Management Strategies: Symptomatic treatment is the cornerstone of acute sinusitis management and includes analgesics such as paracetamol or ibuprofen to relieve pain and fever, and nasal saline irrigation to help clear nasal secretions and improve mucociliary clearance NICE CKS NHS Sinusitis (sinus. Nasal decongestants, either topical or systemic, may be used short term for nasal congestion relief but should not exceed 7 days to avoid rebound congestion NICE CKS SmPC Sudafed,SmPC Sudafed,SmPC Sudafed,SmPC Sudafed. Patient education is crucial to inform about the natural course of the illness, expected symptom duration, and safety-netting advice advising when to seek further medical help, such as worsening symptoms or failure to improve after three weeks NICE CKS NICE NG63. Addressing comorbid conditions like allergic rhinitis with antihistamines or intranasal corticosteroids can also reduce the risk of recurrent sinus infections and improve symptom control NICE CKS Ahmed et al. 2026. Smoking cessation and avoidance of allergens or irritants can further support recovery and reduce exacerbations NICE CKS Ahmed et al. 2026. For persistent or complicated cases, referral to specialist ENT services may be warranted NICE CKS.

Diagnostic Considerations and Stewardship: The diagnosis of bacterial sinusitis should be clinical, supported by symptom duration and severity, without routine imaging or laboratory tests NICE CKS Christensen et al. 2026. C-reactive protein (CRP) testing may aid diagnostic uncertainty but should not replace clinical judgment and must be interpreted cautiously alongside symptoms Christensen et al. 2026. Avoiding unnecessary antibiotics in viral sinusitis is vital to reduce antimicrobial resistance, with emphasis on shared decision-making to align patient expectations with evidence-based care NICE CKS NICE NG63 Christensen et al. 2026.