The evidence-based guidelines for the diagnosis and initial management of suspected acute bacterial rhinosinusitis (ABRS) in adults and children were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America comprising clinicians and investigators representing internal medicine, pediatrics, emergency medicine, otolaryngology, public health, epidemiology, and adult and pediatric infectious disease specialties. Recommendations for diagnosis, laboratory investigation, empiric antimicrobial treatment and adjunctive therapy were developed.

Recommendations: Intranasal saline irrigation with either physiologic or hypertonic saline is recommended as an adjunctive treatment in adults with ABRS (weak, low-moderate).

Several studies evaluated the role of hypertonic vs physiologic saline on nasal airway patency and mucociliary clearance in patients with symptomatic rhinosinusitis. Both saline preparations significantly improved mucociliary clearance compared with pretreatment values; however, only physiologic saline significantly improved nasal airway patency.

In other studies, hypertonic saline was found to significantly improve nasal symptoms as well as global quality of life.

Finally, it is postulated that saline irrigation improves nasal symptoms by enhancing mucociliary function, decreasing mucosal edema, mechanically clearing inspissated mucus, and decreasing inflammatory mediators.

Benefits: Intranasal saline irrigation may relieve symptoms in both children and adults, and improve diseasespecific quality of life. The recommendation in favor of saline irrigation places a relatively high value on potential benefits of increased comfort and safety of the saline irrigations, and relatively low value on local adverse effects such as irritation and a burning sensation.

Source:IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults, Infectious Diseases Society of America, 2012.