Acute Rhinosinusitis
This guidance summarises the NICE Sinusitis (acute) Guidance published in 2017, and the NICE RTIs Guidance published in 2008
No antibiotics - offer self care first line
First line for delayed:
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
OR: 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
Symptoms <10 days: do not offer antibiotics as most resolve in 14 days without, and antibiotics only offer marginal benefit after 7 days (NNT15).
Symptoms >10 days: no antibiotic, or back-up antibiotic 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.
Suspected complications: eg sepsis, intraorbital or intracranial, refer to secondary care.
Self-care: paracetamol/ibuprofen for pain/fever. Nasal decongestants or saline may help some.