Acute Sinusitis
Antimicrobial prescribing: NHS Forth Valley
Further information:
NICE Clinical Knowledge Summaries - Acute sinusitis
Non-surgically obtained microbiology samples (nasal swabs/secretions) are NOT useful in management of acute or chronic sinusitis and should not be sent.
Symptoms <10 days: do not offer antibiotics as most resolve in 14 days without, and antibiotics only offer marginal benefit after 7 days
Symptoms >10 days: no antibiotic, or back-up antibiotic only if several of: purulent nasal discharge; severe localised unilateral pain; fever; marked deterioration after initial milder phase.
Systemically very unwell, or more serious signs and symptoms: immediate antibiotic and consider if admission required e.g. suspected complications (sepsis, peri/intra-orbital, intra-cranial, reduced GCS)
Always offer self-care advice: paracetamol/ibuprofen for pain/fever. Nasal decongestants or saline have limited evidence of benefit but may help some.
If symptoms >10 days: consider high-dose nasal corticosteroid (if over 12 years) for 14 days
Drug details
Phenoxymethylpenicillin
500mg QDS
Child
1 to 11 months: 62.5mg QDS or 125mg BD
1 to 5 years: 125mg QDS or 250mg BD
6 to 11 years: 250mg QDS or 500mg BD
12 to 17 years: 500mg QDS or 1000mg BD
5 days.
Penicillin Allergy:
Doxycyline
200mg stat the 100mg OD
5 days
Penicillin allergy age <12yr old:
Clarithromycin
500mg BD
Child
1 month to 11 years:
Under 8 kg - 7.5mg/kg BD
8 to 11 kg - 62.5mg BD
12 to 19 kg: 125mg BD
20 to 29 kg - 187.5mg BD
30 to 40 kg - 250mg BD
12 to 17 years: 250mg to 500mg BD
5 days
Penicillin allergy in pregnancy:
Erythromycin
500mg QDS
5 days