Acute Rhinosinusitis: Comparative Analysis of Treatment Regimens

This review provides a comprehensive comparative analysis of current treatment regimens for acute rhinosinusitis, evaluating symptomatic therapy, antibiotic treatment, intranasal corticosteroids, and surgical interventions. The manuscript synthesizes current evidence and clinical guidelines to support evidence-based management and optimize patient outcomes while reducing unnecessary antibiotic use. Background: Acute rhinosinusitis (ARS) is a common upper respiratory tract infection 11 with significant morbidity. Despite various treatment options, the optimal regimen re-12 mains debated. This study aims to compare the efficacy and safety of different treatment 13 strategies for ARS, including antibiotics, symptomatic therapy, and corticosteroids. 14 Acute rhinosinusitis (ARS) is a prevalent condition affecting the upper respiratory tract, 15 often triggered by viral or bacterial infections. This study provides a comparative analysis 16 of different treatment regimens to determine their effectiveness, safety, and clinical im-17 pact. Symptomatic treatment, including analgesics, nasal saline irrigation, and decongest-18 ants, remains the cornerstone of management for viral ARS, which constitutes the major-19 ity of cases. However, bacterial ARS, characterized by prolonged or severe symptoms, 20 necessitates antibiotic therapy. Amoxicillin-clavulanate is widely recommended as the 21 first-line antibiotic, with macrolides, cephalosporins, and fluoroquinolones considered for 22 resistant cases or in patients with allergies. 23 Methods: A comparative analysis was conducted on patients diagnosed with ARS, di-24 vided into three groups based on treatment approach: (1) antibiotics (amoxicillin-clavula-25 nate or doxycycline), (2) symptomatic therapy (nasal irrigation, decongestants, antihista-26 mines, and analgesics), and (3) corticosteroid therapy (intranasal or systemic/ intranasal 27 corticosteroids or short-course systemic steroids). Clinical improvement, symptom reso-28 lution time, and adverse effects were assessed over 14 days. The primary outcome 29 measures included symptom resolution time, severity score reduction, and adverse effects 30 over a 14-day follow-up period. 31 Results: Patients in the symptomatic therapy and corticosteroid groups demonstrated sig-32 nificant symptom improvement within the first 5-7 days, comparable to those in the an-33 tibiotic group. However, in confirmed bacterial ARS cases, antibiotics led to faster resolu-34 tion of purulent nasal discharge and facial pain. The corticosteroid group showed notable 35 benefits in reducing nasal congestion and inflammation. Adverse effects, such as gastro-36 intestinal disturbances and allergic reactions, were more frequently observed in the anti-37 biotic and systemic corticosteroid groups. Conclusion: Symptomatic management and intranasal corticosteroids are effective for 39 most ARS cases, while antibiotics should be reserved for severe bacterial infections. Opti-40 mizing treatment strategies can reduce antibiotic overuse and associated resistance. 41 For most ARS cases, symptomatic management combined with intranasal corticosteroids 42 provides effective relief, reducing the need for antibiotics. Antibiotics should be reserved 43 for cases with bacterial complications to prevent antimicrobial resistance. A patient-cen-44 tered approach considering symptom severity and risk factors is crucial for optimal treat-45 ment outcomes. 46