Complete clinical resolution within 14 days is to be expected, and if this goal is not met, reevaluation is warranted. Failure to respond clinically within 3 days requires a change to a broader-spectrum agent or a different antimicrobial class. When acute sinusitis is inadequately treated or viral rhinosinusitis causes marked obstruction of sinus drainage, the acute disease may progress to subacute sinusitis. Symptoms last for more than 3 weeks, but the overall intensity is less than that of the preceding acute process. The patient usually has a chronic cough, which is often worse at night, and nasal congestion and sniffling are common complaints.
Fever is uncommon, unless a nes infectious process develops.
Headache and malaise are infrequent problems. Antibiotics are necessary to treat subacute sinusitis, and chronic sinusitis can result if resolution does not occur. Antibiotic options should include treatment with an agen appropriate for partially penicillin-resistant pneumococcus and for H. influenzae. Treatment should continue for a minimum of 14 days, and clinical reevaluation is necessary. Supportive therapy can include oral or topical decongestants and sline nasal lavage.