We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

Diagnosing Acute Bacterial Rhinosinusitis

Micheal S. Benninger, MD; James A. Hadley, MD; J. David Osguthorpe, MD
Arch Intern Med. 2004;164(5):568-570. doi:10.1001/archinte.164.5.568-c.
Text Size: A A A
Published online


We read with interest the article by Bucher et al1 and would like to address a couple of key issues related to the diagnosis of acute bacterial rhinosinusitis (ABRS) that we believe have substantial implications on the outcomes reported by the authors.

The most significant issue is that the criteria used for making the diagnosis of ABRS are not consistent with standards established by multiple organizations and in a large number of reports.28 In 1996, the Rhinosinusitis Task Force of the American Academy of Otolaryngology–Head and Neck Surgery reported criteria for the diagnosis of ABRS.2,3 The diagnosis was made based on the time from the onset of symptoms and the number and type of symptoms present. Acute bacterial rhinosinusitis was defined as being sudden in onset, with persistent symptoms lasting for 10 days or worsening symptoms after 5 days. Major and minor clinical criteria were identified to make the diagnosis.2,3 In 1999, The US Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) published their evidenced-based report, Diagnosis and Treatment of Acute Bacterial Rhinosinusitis,4,5 with the diagnosis of ABRS defined as lasting for a minimum of 7 days and less than 4 weeks.4,5 A number of subsequent guidelines and literature reviews have recommended similar lengths of time being required to make a diagnosis of ABRS, since infections that do not last a minimum of 7 days are highly likely to be caused by a virus rather than a bacterial pathogen, and bacterial growth can only be detected in 60% of adults with symptoms of 10-day duration or more.69 This includes endorsement by the Centers for Disease Control and Prevention, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians–American Society of Internal Medicine, and the Infectious Disease Society of America.7,8

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
CLINICAL PRACTICE. Acute Sinusitis in Adults. N Engl J Med 2016;375(10):962-70.
Investigation of sinonasal microbiome spatial organization in chronic rhinosinusitis. Int Forum Allergy Rhinol Published online Sep 14, 2016;