Acute Rhinosinusitis

Acute Rhinosinusitis

This guidance summarises the NICE Sinusitis (acute) Guidance published in 2017, and the NICE RTIs Guidance published in 2008

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.

No antibiotics - offer self care first line

First line for delayed:


500mg QDS

5 days.

Penicillin Allergy


200mg Stat the 100mg OD

5 days

Very unwell or worsening:


625mg TDS

5 days.