Treatment of Adult Patients with Acute Bacterial Rhinosinusitis: Official Practice Guideline of the Infectious Diseases and Tropical Medicine Research Center Advisory Committee

Abstract

Context: Acute bacterial rhinosinusitis (ABRS) is a significant public health concern, affecting approximately 15% of the population annually, with a higher prevalence among women. The bacterial etiology primarily includes Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Due to regional variations in bacterial resistance patterns, there is a critical need for localized and evidence-based guidelines for better management in Iranian patients. Evidence Acquisition: A multidisciplinary team reviewed literature from Iranian and international databases published between January 1990 and 2024. Studies included epidemiological data on ABRS prevalence, bacterial resistance patterns, and clinical outcomes. Results: First-line empirical antibiotic therapy for uncomplicated ABRS in Iran includes amoxicillin-clavulanate (500 mg/125 mg three times daily or 875 mg/125 mg twice daily). In cases with high antibiotic resistance, high-dose amoxicillin-clavulanate (2000 mg/125 mg extended-release tablets twice daily) is preferred. Respiratory fluoroquinolones (levofloxacin or moxifloxacin) are recommended for penicillin-allergic patients, with alternative options for non-type I hypersensitivity cases. Conclusions: The guideline standardizes the antimicrobial approach to ABRS in Iran, considering local resistance patterns and clinical evidence.