Which clinical scenario would indicate antibiotic therapy for acute sinusitis according to the stated criteria?

• A. No fever, mild symptoms for 7 days
• B. Fever 38C, intense facial pain, purulent discharge, 5 days
• C. Fever 39C, intense facial pain, purulent discharge, still symptomatic after 7 days
• D. Fever 39C, no facial pain, purulent discharge, 7 days

Answer: (C)

Acute sinusitis antibiotics are most appropriately used when there is evidence the illness is bacterial rather than viral—typically severe symptoms at onset or persistence/worsening of symptoms beyond a week. The scenario described shows a high fever (39°C), intense facial pain, purulent discharge, and ongoing symptoms for about a week. This combination points toward a bacterial process and meets the threshold for antibiotic therapy because the illness has persisted with significant symptoms beyond the typical viral course. The other scenarios either lack the severity (no fever or mild symptoms), miss key features (facial pain), or don’t demonstrate persistence long enough to meet the usual criteria, so they are not the best indication for antibiotics.