Sinusitis

Only 0.5 - 2.2% of acute viral sinusitis becomes complicated by a bacterial infection.

Bacterial cause is more likely if more than one of the following are present:

• Symptoms > 10 days
• Discoloured or purulent nasal discharge
• Severe localised unilateral pain (particularly pain over teeth and jaw)
• Fever
• Marked deterioration after an initial milder phase

Antimicrobial Recommendation

Do not offer antibiotics if symptoms have been present for 10 days or less.

Symptoms with no improvement for more than 10 days? NICE recommends considering a high dose nasal corticosteroid for 14 days for adults and children aged 12+ (off label use). If symptoms do not improve over the consider prescribing an antibiotic.

Offer an immediate antibiotic if the person is systemically very unwell, or has symptoms and signs of a more serious illness or condition, or has high risk of complications.

Recommended total duration: 5 days

Notes

Likely organisms: The most common bacterial causes are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus.  

Refer severe cases to ENT.