ARS is a very commonly encountered condition with symptoms as nasal blockage or congestion and anterior or posterior rhinorrhea. Occurrence of facial pain or pressure and loss of smell are common in adults while cough is cardinal in children. Tests arent needed and the diagnosis is clinical.

Bacterial and non-bacterial sinusitis nearly have similar symptoms, so sparing the symptomatic treatment antibiotics use must be limited only to bacterial sinusitis. The differentiating features between the 2 include the presence of- fever, unilateral focality, local pain, and elevation of CPR/ERS in Bacterial ARS.

Regimen for Bacterial ARS:

use of antibiotics, especially amoxicillin/penicillin (beta-lactams) in adult patients, Sodium hyaluronate plus saline solution for an additive effect to antibiotics, Oral corticosteroids with antibiotics for reducing facial pain are the recommended symptomatic treatment options.

use of topical and oral corticosteroids, antihistamines, decongestants, and saline and steam inhalation needs further investigation in the treatment of Bacterial ARS.

The use of antibiotics for the treatment of Bacterial ARS must be done cautiously as it can lead to antibiotic resistance among the groups and also some major complications. 

Source: Curr Allergy Asthma Rep 20, 28 (2020). https://doi.org/10.1007/s11882-020-00917-5