Acute bacterial rhinosinusitis (ABRS) is a common complication of viral upper respiratory tract infections and is associated with a significant socioeconomic burden. Guidelines for the diagnosis and management of ABRS have been produced in association with a number of societies in the United States; these guidelines aim to promote the rational selection of antibiotic therapy to optimize clinical outcomes while minimizing the potential for selection of antibiotic resistance. This article provides an overview of current U.S. guidelines for the treatment of ABRS, focusing on the impact of antibiotic resistance on treatment options.