Evidence-Based Evaluation and Treatment of Acute Rhinosinusitis in Adults (Infectious Disease CME, Pharmacology CME, and Risk Management CME)

Publication Date: October 2026 (Volume 5, Number 10)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 10/01/2029.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Ethics CME credits and 0.25 Risk Management CME credits, subject to your state and institutional approval.

Author

Tracey Quail Davidoff, MD, FCUCM

Editor-in-Chief, Evidence-Based Urgent Care; Assistant Professor, Family Medicine, Florida State University College of Medicine; Attending Physician, BayCare Urgent Care, Tampa, FL

Abstract

Nasal congestion, sinus pain, and facial pressure are common complaints in urgent care, but determining which patients need symptomatic care alone and which may benefit from antibiotics can be challenging. Patients’ prior experiences with these illnesses often shape their treatment expectations, further complicating management decisions. This review presents best practices for evaluating and treating patients with nasal and sinus symptoms, including strategies for managing expectations when patients request treatments that are not clinically indicated or may cause harm.

Case Presentations

CASE 1

A 45-year-old woman presents to urgent care with 3 days of sore throat, runny nose, nasal congestion, and cough...

She has no significant past medical history.
She says that her typical sinus infection pattern begins with a sore throat, followed by anterior nasal drip, congestion, and cough. She states she gets 2 or 3 of these illnesses per year.
She is usually treated with a 5-day course of azithromycin and a “steroid pack.”
You wonder if you should treat her in the same manner, or do something different…

CASE 2

A 35-year-old man presents with a 15-day history of cold symptoms...

He states he was sure it was just a cold, and had been getting better for a few days, but in the last few days he suddenly felt worse, with increasing pain and pressure in his face.
He has no significant past medical history.
You wonder if there is anything you can do to help him…

CASE 3

A 73-year-old woman presents to urgent care with a 5-day history of right-sided cheek pain, nasal congestion, fever, and headache...

She appears acutely ill and has a temperature of 103°F.
She has a past medical history of coronary artery disease managed with stents, type 2 diabetes treated with multiple medications, and psoriatic arthritis treated with adalimumab.
You notice that the right side of her face appears red and swollen, and the nasolabial fold is obliterated.
You wonder if it is safe for you to treat her as an outpatient…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.