The information below is based on NICE NG79 Sinusitis (acute): antimicrobial prescribing (October 2017).

Acute sinusitis is self-limiting and usually triggered by a viral infection of the upper respiratory tract.

Symptoms can last for 2 to 3 weeks – most people will get better within this time without treatment, regardless of cause (bacteria or virus).

For children under 5 years who present with fever refer to NICE NG143: Fever in under 5s: assessment and initial management (November 2021)

Self-care advice:

• Consider paracetamol or ibuprofen for pain or fever
• Patients may wish to try nasal saline or nasal decongestants, although there is not enough evidence to show that they help to relieve nasal congestion.

The following are not recommended due to a lack of evidence: oral decongestants, antihistamines, mucolytics, steam inhalation, or warm face packs.

Consider prescribing a nasal corticosteroid for 14 days for adults and children aged 12 years and over (unlicensed use), see section 12.2.1 Drugs used in nasal allergy. Be aware that nasal corticosteroids may improve symptoms but are not likely to affect how long they last; could cause systemic effects, particularly in people already taking another corticosteroid; and may be difficult for people to use correctly.

Consider a 5 day prescription (delayed for 7 days) for patients presenting with symptoms for around 10 days or more with no improvement, taking account of evidence that antibiotics make little difference to how long symptoms last, or the proportion of people with improved symptoms (refer to 1st line treatments below).

Immediate prescription of antibiotics is recommended in the following patients (refer to 2nd line treatments below):

• Are systemically very unwell
• Show signs and symptoms suggestive of serious illness and/or complications
• Are at risk of developing complications because of pre-existing co-morbidity, including significant heart, lung, renal, liver or neuromuscular disease, immunosuppression, cystic fibrosis and young children born prematurely
• Are older than 65 years with acute cough and two or more of the following criteria; or older than 80 years with acute cough and one of more of the following criteria:
  • Hospitalisation in previous year
  • Type 1 or type 2 diabetes
  • History of congestive heart failure
  • Current use of oral glucocorticoids

Where antibiotics are indicated

1st line

If systemically very unwell, symptoms and signs of a more serious illness or condition, or at high risk of complications, refer to "2^nd line".

Phenoxymethylpenicillin

(including pregnancy)

• Adults over 18 years of age:
  • 500mg four times a day for 5 days
• Children 1 month to 17 years of age (doses given four times a day for 5 days):
  • 1 month to 11 months: 62.5mg
  • 1 to 5 years: 125mg
  • 6 to 11 years: 250mg
  • 12 to 17 years: 500mg

Penicillin allergy in adults/ children over 12 years

Doxycycline

• Adults and children over 12 years of age:
  • 200mg single starting dose, then 100mg daily for total of 5 days
• For children under 12 years of age give clarithromycin (see below)
• Not for use in pregnancy: give erythromycin (see below)

Penicillin allergy in children under 12 years

Clarithromycin

• Children 1 month to 11 years of age (doses given twice daily for 5 days):
  • Body-weight under 8kg: 7.5mg/kg
  • Body-weight 8–11kg: 62.5mg
  • Body-weight 12–19kg: 125mg
  • Body-weight 20–29kg: 187.5mg
  • Body-weight 30–40kg: 250mg

Penicillin allergy in pregnancy

Erythromycin

• 250mg to 500mg four times a day for 5 days

See 5.1.1 Penicillins, 5.1.3 Tetracyclines, and 5.1.5 Macrolides

2nd line

If systemically very unwell, symptoms and signs of a more serious illness or condition, at high risk of complications, or if worsening of symptoms on first choice taken for at least 2 to 3 days.

Co-amoxiclav

• Adults over 18 years of age:
  • 625mg three times a day for 5 days
• Children 1 month to 17 years of age (doses given three times a day for 5 days):
  • 1 to 11 months: 0.25ml/kg (125/31mg/5ml suspension)
  • 1 to 5 years: 5ml or 0.25ml/kg (125/31mg/5ml suspension)
  • 6 to 11 years: 5ml or 0.15ml/kg (250/62mg/5ml suspension)
  • 12 to 17 years: 250/125mg or 500/125mg

If worsening of symptoms on second line treatment option, taken for at least 2-3 days, or penicillin allergy consult local microbiologist.

See 5.1.1 Penicillins