In acute sinusitis, antibiotic therapy is indicated when symptoms have persisted for 10 days or there is facial swelling and fever.

• A. Symptoms present for 10 days or facial swelling and fever
• B. Symptoms present for 5 days
• C. Symptoms present for 3 days
• D. No antibiotics ever

Answer: (D)

Understanding when antibiotics are worth using for acute sinusitis hinges on distinguishing viral from bacterial infection and recognizing when the illness has reached a threshold where antibiotics provide real benefit. Most acute sinusitis cases are viral and self-limited, so antibiotics aren’t needed right away. Antibiotics are indicated when symptoms have persisted for about ten days without improvement, or when there are more severe features such as facial swelling with fever. Those criteria help target treatment to cases likely caused by bacteria and reduce unnecessary antibiotic use.

So the option describing either ten days of symptoms or the combination of facial swelling with fever aligns with guidelines for initiating antibiotics. Shorter durations, like five or three days, don’t meet the threshold and may reflect a viral illness. The choice that suggests never using antibiotics ignores real scenarios in which bacterial sinusitis would benefit from antibiotic therapy.