Acute Sinusitis - delayed antibiotic strategy

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC). See guidance on dosing in children for quick reference dosage/weight guide. Refer to drug interactions table for detailed drug interactions for all antimicrobials. Note extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.

Note additional warnings for clarithromycin and fluoroquinolones

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)


Consider a no or delayed antibiotic strategy. A+

If antibiotics deemed clinically indicated:

acute sinusitis table 2019 May 23

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.

Reviewed - Dec 2019

Patient Information

Visit HPSC Information Leaflets pages for the General Public, (MRSA, CRE, etc)

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