Sinusitis, acute, bacterial

J01.0-4/J01.8-9

DESCRIPTION

Bacterial infection of one or more paranasal sinuses that occurs most often after a viral nasal infection or allergic rhinitis.

Bacterial sinusitis is characterised by:

  • Deterioration of a common cold after 5–7 days.
  • Headache.
  • Purulent nasal discharge, especially if unilateral.
  • Pain and tenderness over one or more sinuses.
  • Nasal obstruction.
  • Fever.

Note: Sinusitis is uncommon in children < 5 years of age, as sinuses are not fully developed.

GENERAL MEASURES

Consider HIV in recurrent sinusitis.

MEDICINE TREATMENT

Children ≤ 3 years of age

  • Amoxicillin, oral, 45 mg/kg/dose 12 hourly for 5 days.

Sinusitis Acute Bacterial Medicine Treatment.png

Children > 3 years of age

  • Amoxicillin<, oral, 500 mg 8 hourly for 5 days.

Adults

  • Amoxicillin, oral, 500 mg 8 hourly for 5 days.

Severe penicillin allergy (Z88.0)

Children

  • Macrolide, e.g.:
  • Azithromycin, oral, 10 mg/kg/dose, daily for 3 days. See paediatric dosing tool.

Children > 35 kg and adults

  • Macrolide, e.g.:
  • Azithromycin, oral, 500 mg daily for 3 days.

AND

  • Oxymetazoline, nose drops, 2 drops in each nostril 6–8 hourly for not more than 5 days continuously.
    • Children > 5 years of age: 0.025%
    • Adults: 0.05%

LoEIII [13]

AND/OR

  • Sodium chloride 0.9%, nose drops, use frequently and in fairly large volumes.

Pain:

Children

  • Paracetamol, oral, 10–15 mg/kg/dose 6 hourly when required. See paediatric dosing tool.

Adults

  • Paracetamol, oral, 1 g 4–6 hourly when required.
    • Maximum dose: 15 mg/kg/dose.
    • Maximum dose: 4 g in 24 hours.

REFERRAL

  • Fever lasting > 48 hours.
  • Poor response > 5 days.
  • Complications, e.g. periorbital cellulitis with periorbital swelling.
  • Oedema over a sinus.
  • Recurrent sinusitis.
  • Meningeal irritation.