Do we need antibiotics in acute rhinosinusitis?

New guidelines for acute bacterial rhinosinusitis are now available from The Infectious Diseases Society of America. The guidelines used the GRADE system (Grading of Recommendations, Assessment, Development and Evaluation), a state-of-the
art methodology for developing evidence-based guidelines. The paper is published in Clinical Infectious Diseases (Clin Infect Dis 2012; doi: 10.1093/cid/cir1043). The guidelines aim to provide clarity and guidance that will aid physicians in diagnosis and treatment of acute bacterial rhinosinusitis, both in children and in adults. As the guidelines point out, no clinical criteria can currently differentiate between viral and bacterial rhinosinusitis, which leads to excessive antimicrobial therapy. The authors propose an algorithm for management that is based on risk assessment for antimicrobial resistance and evolution of clinical responses.