Sinusitis, acute bacterial
See NICE guideline 79 - Sinusitis (acute): antimicrobial prescribing
No antibiotics indicated unless:-
- Symptoms more than 10 days
- Pain/purulent nasal discharge (not improving)
- Severe disease with systemic symptoms (such as fever over 39 deg C)
For complications including intracranial/periorbital disease see separate guidelines and discuss with Micro/ID:
Brain abscess
Peri-orbital cellulitis
Treat for 3-5 days
Mild Disease
Preferred
phenoxymethyl penicillin (penicillin V) 500mg po qds (or 1g po bd if this would help adherence)
Alternative if previously treated with phenoxymethypenicillin or amoxicillin within 2 weeks:
- doxycycline 100mg po bd
- OR co-trimoxazole 960mg po bd
- OR cefalexin 1g po tds
Severe disease and/or at high risk of complications
Preferred
amoxicillin 1g iv tds
If no improvement or worsening after 2 days: change to co-amoxiclav 1.2g iv tds
Oral follow on treatment: as for mild disease above
For penicillin allergy (non-severe or severe)
co-trimoxazole 960mg po bd (or IV if NBM)
OR
clarithromycin 500mg po bd (or IV if NBM) (If pregnant: erythromycin 500mg po qds)