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Editor's Correspondence
March 8, 2004

Diagnosing Acute Bacterial Rhinosinusitis

Arch Intern Med. 2004;164(5):568-570. doi:10.1001/archinte.164.5.568-c

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.2-8 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.6-9 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