Acute Rhinosinusitis

Case Definition:

Inflammation of the nose and the paranasal sinuses.

 

Diagnostic criteria:

Symptoms include nasal blockage or obstruction or a nasal discharge. Facial pain and hyposmia/anosmia may be present. Evidence of a mucopurulent discharge from the middle meatus within the nose is required evidence to support the diagnosis.

 

Specimens to be collected:

Swab from nasal cavity/middle meatus

 

Notes

NICE guidance on URTI indicates that antibiotics are not routinely indicated for category A patients with acute rhinosinusitis. 80% resolve within 14 days without antibiotics as the cause may be viral. There is no benefit of antibiotics within the first 7 days of symptoms and only marginal benefits after 7 days with 15 patients requiring treatment to see benefit in one patient compared to having no antibiotics. Adequate analgesia is required.

Antibiotics may be of benefit if there is purulent nasal discharge (8 patients treated to see additional benefit over no antibiotics).

 

Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)
A

Minor to moderate infection

Review doses in renal impairment

Antibiotics not routinely indicated (see above)

AMOXICILLIN 500mg po tds

Typical total duration: 7 days

Antibiotics not routinely indicated (see above)

DOXYCYCLINE 200mg po od
OR
CLARITHROMYCIN 500mg po bd

Typical total duration: 7 days

B/C

Moderate to severe life threatening infection 

Review doses in renal impairment

CO-AMOXICLAV 1.2g iv tds

 Typical total duration: 7 days

Non-Severe Allergy:

  • < 65 years old

CEFTRIAXONE 2g iv od
Plus
METRONIDAZOLE 400mg po tds

  • >65 years old

MEROPENEM 500mg iv tds

Severe Penicillin Allergy:

TEICOPLANIN iv every 12 hours for 4 doses then once daily.

Dose
<50kg: 400mg
50-100kg: 600mg
>100kg: 800mg 
Maintain treatment pending pre-dose (trough) level on Day 5. Target level 15-60mg/L.

Plus
LEVOFLOXACIN  500mg po bd
Plus
METRONIDAZOLE 400mg po tds

Typical total duration: 7 days

 IV to Oral Switch (explanatory notes

CO-AMOXICLAV 625mg tds

Typical total duration : 7 days

LEVOFLOXACIN 500mg po od
plus
METRONIDAZOLE 400mg po tds

Typical total duration: 7 days

If diabetic patient and/or fungal sinusitis infection suspected contact Microbiology Consultant.

Last reviewed:23/04/14

 For guidance on the administration of intravenous antibiotics
click here (GHNHSFT intranet only)