James Fan, MD; Jason T. Alexander, MD
GUIDELINE TITLE Adult Sinusitis Update 
RELEASE DATE June 17, 2025
PRIOR VERSION 2015
DEVELOPER American Academy of Otolaryngology–Head
and Neck Surgery Foundation (AAO-HNSF)
TARGET POPULATION Adults with rhinosinusitis
MAJOR RECOMMENDATIONS
• Acute bacterial rhinosinusitis is defined as presence of
purulent nasal drainage associated with nasal obstruction
and facial pain, pressure, or fullness that persists without
improvement for at least 10 days or that worsens within 10
days after initial improvement (strong recommendation;
quality of evidence [QOE]: B).
• Radiologic imaging should not be obtained for patients
with acute rhinosinusitis unless a complication such as
orbital or soft tissue involvement or alternative diagnosis
is suspected (recommendation against; QOE: B).
• Adults with uncomplicated acute bacterial rhinosinusitis
should be offered watchful waiting (without antibiotics)
with follow-up 3 to 5 days after diagnosis to reassess
need for antibiotics (recommendation; QOE: A).
• If antibiotics are prescribed for acute bacterial
rhinosinusitis, amoxicillin with or without clavulanate for 5
to 7 days should be used in most adults (recommendation;
QOE: A). Doxycycline is an alternative for persons with
immunoglobulin E (IgE)–mediated penicillin allergy.
