Acute Sinusitis (Adults) - delayed antibiotic strategy

Comments from Expert Advisory Committee

  • Most are viral. Symptomatic benefit of antibiotics is small.
  • Consider a no or delayed antibiotic strategy
  • Use NSAID or paracetamol for pain relief
  • Consider high dose intranasal steroids
  • 80% resolve in 14 days without antibiotics and they only offer marginal benefit after 7 days (NNT 15)
  • Reserve antibiotics for severe cases systemically very unwell or symptoms >10 days.

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)
  • Fever
  • Marked deterioration after an initial milder phase

In persistent infection use an agent with anti-anaerobic activity e.g. co-amoxiclav.

Little evidence of benefit but patients may wish to try systemic decongestants, e.g. pseudoephedrine or Topical decongestants, e.g. oxymetazoline, xylometazoline, or Saline preparations for local irrigation (e.g. nasal rinses, sprays, drops)


sinitus table 040321_2

* Alternative doxycycline dose: 100mg every 12 hours. 
In non-severe infection, 200mg stat then 100mg every 24 hours can be considered.

Patient Information

We recommend patients use the website developed by HSE/ICGP/IPU partnership 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.

Safe Prescribing (visit the safe prescribing page)

Reviewed February 2021

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