Section 1 : About this Course
Section 2 : A respiratory Appointment
Section 3 : An appointment for Ear, Nose, and Throat
Section 4 : It may be nothing but lets check that chest pain out
HALF WAY THERE
Section 5 : A typical day at work
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Sinusitis

Pocket patient Pat has been told by out of hours that they have sinusitis and were advised to buy a nasal spray from their local pharmacy. They are not sure what sort of nasal spray and would like to know if there is anything else they can do to improve their symptoms. They have had similar symptoms twice this year.

Acute sinusitis (also known as rhinosinusitis) is self-limiting and usually triggered by a viral infection of the upper respiratory tract (for example, a common cold) one of our aims should be to limit antimicrobial medication.

Excercise 14: Follow the link in the materials section and answer the following questions in the workbook

  1. How do you decide whether this is Acute sinusitis or chronic?
  2. What are the four main symptoms of sinusitis?
  3. What is the main complication of sinusitis?
  4. What could be one of the main causes of sinusitis in Pat’s case?
  5. What will probably happen if Pat is prescribed the same antibiotic again and again?
  6. What percentage of people have bacterial sinusitis?
  7. Pat has had symptoms for 6 days now and is asking you if they should have resolved by now. How long can Pat expect to get symptoms for?
  8. If their symptoms last longer than that with no improvement, what should your treatment be?

The table below are the National CKS Guidelines. Always refer to your local formulary and policies for treatment in your area and always keep up to date with any changes or new information..

TreatmentAntibiotic, dosage and course length
First-choice oral antibioticPhenoxymethylpenicillin: 500 mg four times a day for 5 days.
First choice if systemically very unwell, symptoms and signs of a more serious illness or condition, or at high risk of complicationsCo‑amoxiclav: 500/125 mg three times a day for 5 days.
Alternative first choices for penicillin allergy or intolerance (for people who are not pregnant)Doxycycline: 200 mg on first day, then 100 mg once a day for 4 days (5-day course in total) Clarithromycin: 500 mg twice a day for 5 days.
Alternative first choice for penicillin allergy in pregnancyErythromycin: 250 mg to 500 mg four times a day or 500 mg to 1,000 mg twice a day for 5 days Erythromycin is preferred if a macrolide is needed in pregnancy, for example, if there is true penicillin allergy and the benefits of antibiotic treatment outweigh the harms. See the Medicines and Healthcare products Regulatory Agency (MHRA) Public Assessment Report on the safety of macrolide antibiotics in pregnancy.
Second-choice oral antibiotic (worsening symptoms on first choice taken for at least 2 to 3 days)Co‑amoxiclav: 500/125 mg three times a day for 5 days.
Alternative second choice for penicillin allergy or intolerance, or worsening symptoms on second choice taken for at least 2 to 3 daysConsult a local microbiologist.

See the BNF for appropriate use and dosing in specific populations, for example, hepatic impairment, renal impairment, pregnancy and breast-feeding.

If co‑amoxiclav has been used first choice, consult a local microbiologist for advice on second choice.