Synopsis
Separate self-limiting acute infection from persistent sinonasal inflammation, prescribe antibiotics selectively, and escalate orbital or intracranial complications without delay.
- An uncomplicated acute episode usually lasts two to three weeks, and most patients do not need antibiotics.
- Symptoms for around ten days or less generally warrant supportive care with explicit deterioration advice.
- After at least ten days without improvement, consider a fourteen-day high-dose intranasal corticosteroid course in adults and children aged twelve or over.
Key red flags
New eye swelling with diplopia, restricted movement or visual change requires immediate hospital assessment for orbital spread.
Investigation priorities
Identify uncomplicated acute disease and exclude immediate complications.
Management branches
Symptoms have lasted around ten days or less without significant systemic illness.
- Explain the expected course and offer suitable analgesia with attention to individual contraindications.
- Saline may be tried for comfort, while explaining that evidence for symptom relief in acute sinusitis is limited.
Key medicines
Phenoxymethylpenicillin for uncomplicated acute sinusitis when antibiotics are indicatedFor adults aged eighteen or over, give 500 mg orally four times daily for five days, following NICE NG79 when an antibiotic is appropriate.
Co-amoxiclav for higher-risk or second-choice treatmentFor adults, give 500/125 mg orally three times daily for five days. NICE selects it initially for systemic illness or high complication risk, or after deterioration on a first-choice antibiotic for at least two to three days.