Sinusitis

Analgesia, no antibiotic treatment (majority resolve in 14 days) refer to prescribing notes.

2 sprays every 12 hours into each nostril.

If there is no response after 2 weeks, continue beclometasone and consider antibiotic treatment.

500mg every 6 hours for 5 days

If penicillin allergic, prescribe doxycycline.

200mg on day 1, then 100mg daily for 5 days treatment in total

In pregnancy and penicillin allergic.

500mg every 6 hours for 5 days

Prescribing Notes:

Ensure adequate use of analgesics.
Evidence of benefit from nasal saline or nasal decongestants is lacking but may be considered for symptomatic relief.
The role of antibiotics in the treatment of sinusitis is controversial.
Antibiotics are not recommended for patients who are systemically well, not at risk of complications and symptom duration of less than 10 days. If there is no improvement after 10 days consider delayed antibiotic prescription depending on likelihood of bacterial cause.
Consider prescribing an intranasal corticosteroid for people with prolonged or severe symptoms.
Antibiotics can be considered for patients with suspected acute bacterial sinusitis when at least three of the following are present (or if the patient is at high risk of complications)
- discoloured or purulent discharge (with unilateral predominance)
- severe local pain (with unilateral predominance)
- a fever greater than 38 degrees Celsius
- a marked deterioration after an initial milder form of the illness (so-called 'double-sickening')
- elevated ESR/CRP (although the practicality of this criterion is limited).

History Notes

06/06/2024

Erythromycin ethyl succinate 500mg/5ml oral suspension sugar free discontinued and removed

15/12/2021

East Region Formulary content agreed.

Analgesia, no antibiotic treatment (majority resolve in 14 days) refer to prescribing notes.

Children > 12 years consider prescribing high dose nasal corticosteroid.

See BNFc for dose, duration 14 days.

If there is no response after 2 weeks, continue beclomethasone (if started) and consider antibiotic treatment.

For dose and duration see BNFc.

If penicillin allergic, prescribe clarithromycin.

For dose and duration see BNFc.

If penicillin allergic and > 12 years an alternative is doxycycline.

For dose and duration see BNFc.

If systemically very unwell, symptoms or signs of a more serious illness or condition are present, or there is a high risk of complications, prescribe co-amoxiclav.

For dose and duration see BNFc.

Prescribing Notes:

Ensure adequate use of analgesics.
Evidence of benefit from nasal saline or nasal decongestants is lacking but may be considered for symptomatic relief.
The role of antibiotics in the treatment of sinusitis is controversial.
Antibiotics are not recommended for patients who are systemically well, not at risk of complications and symptom duration of less than 10 days. If there is no improvement after 10 days, consider delayed antibiotic prescription depending on likelihood of bacterial cause.
Consider prescribing an intranasal corticosteroid for children aged 12 years and over with prolonged or severe symptoms.
Antibiotics can be considered for patients with suspected acute bacterial sinusitis when at least three of the following are present (or if the patient is at high risk of complications):
- discoloured or purulent discharge (with unilateral predominance)
- severe local pain (with unilateral predominance)
- a fever greater than 38 degrees Celsius
- a marked deterioration after an initial milder form of the illness (so-called 'double-sickening')
- elevated ESR/CRP (although the practicality of this criterion is limited).
For more information refer to NICE CKS: Sinusitis.

History Notes

15/01/2024

East Region Formulary content agreed.