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