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


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


200mg stat the 100mg OD

5 days

OR: Clarithromycin

500mg BD


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