Acute Sinusitis

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This is an acute infection of the para-nasal sinuses. It may lead to complications with attendant morbidity and mortality. Early recognition of this clinical condition is mandatory.  

Swimming in dirty waters, dental infection or dental extraction, fractures involving the sinuses, nasal obstruction from polyps and allergic rhinitis are predisposing factors to developing acute sinusitis.

Cause

  • Viral (common cold)
  • Bacterial 
  • Group A haemolytic Streptococci 
  • S. pneumonia
  • S. aureus
  • H. influenzae
  • M. catarrhalis 
  • Allergy

Symptoms

  • Cough
  • Nasal congestion
  • Pressure in the face and head
  • Frontal headaches
  • Postnasal drip 

Signs

  • Yellow or green thick nasal discharge, which may be foul smelling
  • Halitosis
  • Persistent fever
  • Tenderness above and below the eyes, when patient bends over or when these areas are tapped lightly

Investigations

  • FBC 
  • X-ray of paranasal sinuses   

TreatmentTreatment Objectives

  • To reduce symptoms of pain and fever
  • To eradicate infection
  • To encourage drainage of sinuses

Non-pharmacological treatment

  • Adequate hydration 
  • Steam inhalation  
  • Tooth extraction under antibiotic cover (if dental focus of infection is present) 

Pharmacological treatment 

For treatment of bacterial infection

1st Line Treatment

Evidence Rating: [B]

  • Amoxicillin, oral, 

Adult

500 mg 8 hourly for 10 days

Children

6-12 years; 250 mg 8 hourly for 10 days

1-5 years 125 mg 8 hourly for 10 days

< 1 year; 62.5 mg 8 hourly for 10 days

Or

  • Amoxicillin + Clavulanic Acid, oral,

Adults

1g 12 hourly for 7 days

Children

>12 years; One 500/125 mg tablet 12 hourly for 10 days

6-12 years; 5 ml of 400/57 mg suspension 12 hourly for 10 days

1-6 years; 5 ml of 200/28.5 mg suspension 12 hourly for 10 days

1 month-1 year; 2.5 ml of 200/28.5 mg suspension 12 hourly; dose  doubled in severe infection

2 weeks-1 month; 1.25  ml  of  200/28.5  mg  suspension  12  hourly; dose doubled in severe infection

2nd Line Treatment

Evidence Rating: [B]

  • Cefuroxime, oral, 

Adults 

250-500 mg 12 hourly for 5-7 days

Children

3 months-12 years; 125 mg 12 hourly, double in severe infection

For treatment of bacterial infection in patients with penicillin allergy

  • Erythromycin, oral,

Adults

500 mg 6 hourly for 10 days

Children

2-8 years; 250 mg 6 hourly for 10 days

1 month-2 years; 125 mg 6 hourly for 10 days

Neonate;

12.5 mg/kg 6 hourly

Or

  • Azithromycin, oral,

Adults

500 mg daily for 5 days

Children

10 mg/kg daily for 5 days

For pain relief 

  • Paracetamol, oral, (to relieve pain if present)

Adults

500 mg-1 g 6-8 hourly 

Children

6-12 years; 250-500 mg 6-8 hourly

1-5 years; 120-250 mg 6-8 hourly

3 months-1year; 60-120 mg 6-8 hourly

For nasal decongestion

  • Ephedrine nasal drops 

Adults (1%)

1-2 drops into each nostril up to 4 times daily when required

Children (0.5%)

1-2 drops into each nostril up to 4 times daily when required

Or

  • Neomycin 0.5%/Hydrocortisone 1.5% nasal drops,

Adults

2 drops 12 hourly

Children 

1 drop 12 hourly 

Referral Criteria

Refer all cases, which do not improve after 1 week of treatment to the ENT Specialist