Sinusitis
- Generally antibiotics are not required. Majority of cases resolve in 14-21 days without them (regardless of cause; bacterial or viral)
- Advise adequate analgesia
- Consider treating with antibiotic if most of the following are present:
- Symptoms for more than 10 days
- Marked deterioration after an initial milder phase
- Fever
- Unremitting purulent nasal discharge
- Severe localised unilateral pain (particularly pain over teeth and jaw)
Sinusitis can be associated with CNS complications. This is rare in children under 8 years old. RED FLAGS raising possibility of CNS complications include:
- Severe headache persisting despite regular analgesia (ibuprofen and paracetamol) or worse on lying down/in morning
- Severe retroorbital pain
- Persistent vomiting
- New onset squint or diplopia - covering up one eye
- Deteriorating vision - complaining of blurred vision
- New limb weakness – may exhibit change of hand preference
- Unsteady gait or coordination issues
- Increasing drowsiness
- Meningism/irritability
If intracranial involvement or signs of CNS complications, refer to brain abscess guideline
If patient has not received antibiotics for sinusitis in primary care
Preferred
phenoxymethyl penicillin (penicillin V) po, see dosing table below, for 5 days
The unpleasant taste and palatability of phenoxymethyl penicillin (penicillin V) suspension can affect adherence to antibiotics, which may result in treatment failure. The use of tablets should be encouraged in children over the age of 6 years old. Medicines for Children provide advice about teaching children to swallow tablets.
|
Age |
phenoxymethyl penicillin (penicillin V) oral dose |
|
1 Month to 11 months |
62.5mg QDS or 125mg BD |
|
1 Year to 5 years |
125mg QDS or 250mg BD |
|
6 years to 11 years |
250mg QDS or 500mg BD |
|
12 years to 17 years |
500mg QDS or 1g BD |
If penicillin suspension not tolerated (palatability), use amoxicillin po, see dosing table below, for 5 days.
|
Age |
amoxicillin oral dose |
|
1 month to 11 months |
125mg TDS |
|
1 year - 4 years |
250mg TDS |
|
5 years and over |
500mg TDS |
If severe or orals not tolerated: consider benzylpenicillin 50mg/kg (max=2.4g) iv QDS
For penicillin allergy (non-severe and severe)
Under 6 months: clarithromycin po, see dosing table, for 5 days
|
Weight |
clarithromycin oral dose |
|
Under 8 kg |
7.5mg/kg po BD |
|
8-11 kg |
62.5mg po BD |
|
12-19 kg |
125mg po BD |
6 months to 12 years old: azithromycin 12mg/kg (Max 500mg) po OD for 3 days
12 to 17 years old: azithromycin 500mg po OD for 3 days
If patient has already received a course of phenoxymethylpenicillin or amoxicillin in primary care:
Preferred
Treat for 5 days
co-amoxiclav 30mg/kg (max=1.2g) iv TDS (BD if 1-2 months old)
Oral switch: co-amoxiclav po (see dosing table)
|
Age |
co-amoxiclav oral dose |
|
1 Month to 11 months |
0.5mL/kg of 125mg/31mg/5mL suspension TDS |
|
1 Year to 5 years |
10mLs of 125mg/31mg/5mL suspension TDS |
|
6 years to 11 years |
10mLs of 250mg/62mg/5mL suspension TDS |
|
12 years to 17 years |
One 625mg tablet TDS OR 10mLs of 250mg/62mg/5mL suspension TDS if patient cannot take tablets
|
For penicillin allergy (non-severe and severe)
Under 6 months: clarithromycin po, see dosing table, for 5 days
|
Weight |
clarithromycin oral dose |
|
Under 8 kg |
7.5mg/kg po BD |
|
8-11 kg |
62.5mg po BD |
|
12-19 kg |
125mg po BD |
6 months to 12 years old: azithromycin 12mg/kg (Max 500mg) po OD for 3 days
12 to 17 years old: azithromycin 500mg po OD for 3 days