The symptoms of bacterial rhinosinusitis are associated to the location of sinus involvement. General symptom of acute suppurative rhinosinusitis is pain that can be found on nasal or facial which related with the infected sinus location. It can be marked with headache. The patients have the lasting long time of  symptoms cold, such as nasal obstruction and also discharge from nasal and can be found related systemic symptoms (fever, malaise, and lethargy). It may present unilateral or bilateral mucopurulent nasal discharge that greenish-yellow. Upper respiratory tract infection can be a predisposing factor for this that usually gives effect to both sides and systemic symptoms.

The most important medical management of acute suppurative sinusitis is Antibiotic. For first-line empiric therapy is used amoxicillin as a good choice to pursue both gram-positive and gram-negative germs except strains that have Beta-lactamase enzyme or the highly resistant to penicillin. Beta-lactamase inhibitor such as amoxicillin-clavulanate and ampicillin-sulbactam are synthetic penicillin antibiotics that can be used but they are not effective against penicillin-resistant pneumococci. Germs producing Beta-lactamase enzyme can also covered by second-generation cephalosporins.

As first-line drugs can also use combination of erythromycin and a sulfonamide where for children can use erythromycin-sulfisoxazole and in adult one may have erythromycin and trimethoprim-sulfamethoxazole. It can also use combination of cephalexin and a sulfonamide.

Clarithromycin are the other good choices and faction of quinolones, such as ciprofloxacin have been used to treat sinusitis in adults where it is not recommended for children and pregnant women because of side effects disturb in cartilage formation.
Parenteral antibiotics therapy treat patients with complicated infections that extend into orbital or intracranial. Ceftriaxone is a good choice, it has perfect penetration of the blood-brain barrier. It can also covered by ampicillin-sulbactam and similar agents. Metronidazole is given for anaerobic germs and also has well penetration into the cerebrospinal fluid. For nosocomial sinusitis is used parenteral antibiotics chosen based on culture and available data sensitivity test.

Patients usually show clinical improvement within 48-72 hours of beginning antibiotics therapy. The patients will return to normal temperature, minimum discharge, and especially in children, cough stop well.
However, antibiotic therapy should be continued for a minimum of one week after the symptoms have stopped  existing. So that, treatment usually lasts a 10 days, and often lasts 3 weeks or longer in order to prevent relapse or progress to chronic sinusitis.

It is important to decrease edema around the ostia to give drainage and allow sinus oxygenation for breaking the involved organisms by using topical and systemic decongestants.Topical decongestants such as drops, or sprays giving benefit but it is not applicated for more than 3 days.

Using antihistamines is not recommended and it is considered for allergic rhinosinusitis. Humidification can be useful, especially at bedtime with using a steam or cold water humidifier. To manage pain treat with analgesics. Using mucolytics and expectorants are benefit to some patients especially with problem on thick secretions. The patient who have much nasal secretion may use saline for irrigating nasal, where medical drainage procedures such as Proetz displacement can be used. (the doc b3ty)