Acute Sinusitis (Adults) - delayed antibiotic strategy

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)
  • Fever
  • Marked deterioration after an initial milder phase

Symptom relief:

  • 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.


sinusitis table oct 2021

* 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 October 2021

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