Comments from Expert Advisory Committee
- Acute sinusitis usually follows a common cold, and symptoms for around 10 days or less are more likely to be associated with a cold rather than viral or bacterial acute sinusitis.
- Prolonged symptoms (for around 10 days or more with no improvement) could be due to either viral or bacterial acute sinusitis.
- Bacterial sinusitis is usually self-limiting and does not routinely need antibiotics. 80% resolve in 14 days without antibiotics and they only offer marginal benefit after 7 days.
- Consider high dose intranasal steroids.
- Consider self-care measures and a no antibiotic strategy for patients with symptoms < 10 days unless systemically very unwell.
- Consider a no antibiotic or delayed antibiotic prescription for symptoms > 10 days without clinical improvement.
- Offer an immediate antibiotic prescription for patients systemically very unwell, with signs of severe infection or high risk of complications.
- Refer to hospital if symptoms of sinusitis with a severe systemic infection, intraorbital or periorbital complications.
- Reassess if symptoms worsen rapidly or significantly despite taking treatment.
Bacterial cause may be more likely if several of the following are present:
- Symptoms for more than 10 days
- Discoloured or purulent nasal discharge
- Severe localised unilateral pain (particularly pain over teeth and jaw)
- Marked deterioration after an initial milder phase
- For pain or fever, consider paracetamol (or ibuprofen where appropriate).
- Little evidence of benefit but patients may wish to try systemic decongestants, topical decongestants or saline preparations for local irrigation (e.g. nasal rinses, sprays, drops).
- Advise to consult pharmacist for symptom relief.
* Alternative doxycycline dose: 100mg every 12 hours.
In non-severe infection, 200mg stat then 100mg every 24 hours can be considered.
We recommend patients use the website developed by HSE/ICGP/IPU partnership www.undertheweather.ie for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.
Reviewed October 2021