Acute Purulent Rhinosinusitis

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Bacterial infection with pus accumulation in one or more of the paranasal sinuses.

Investigations
  • Anterior rhinoscopy – watery/purulent nasal discharge occasionally foul-smelling Nasal congestion
  • Plain Paranasal Sinuses X-ray (Water’s, Caldwell views) Mucosal thickening; air-fluid levels
Pharmacological treatment

Clinical Diagnosis

Antibiotic

Duration

Penicillin allergy

Comments

Acute Rhino-sinusitis

 

Antibiotics should ONLY be prescribed in SEVERE infection as this condition can have a viral cause.

 

Acute Bacterial Rhinosinusitis

(severe or persistent symptoms)

 

First line

Amoxicillin/clavulanic acid oral

625mg every 8 hours

 

Second line

Doxycycline oral

100mg every 12 hours

5 days

First line

Clarithromycin oral 500mg every 12 hours

 

Second line

Doxycycline oral

100mg every 12 hours

 

Peri-orbital Cellulitis

 

Clindamycin IV

900mg every 8 hours

 

AND

Ciprofloxacin oral 500mg every 12 hours

 

Oral Step down

Clindamycin oral 450mg 4 times daily

 

AND

Ciprofloxacin oral 500mg every 12 hours

2 weeks

Clindamycin IV 900mg every 8 hours

 

AND

Ciprofloxacin oral 500mg every 12 hours

 

Oral step down

Clindamycin oral

450mg 4 times daily

 

AND

Ciprofloxacin oral

500mg every 12 hours

-   IV to oral switch when clinically suitable (24 – 48hrs)

 

Referral

Refer the following to ENT specialists

  • Children with ethmoiditis presenting as an acute periorbital inflammation or orbital cellulitis must be hospitalized immediately.
  • Adults with pronounced symptoms despite treatment. If sinusitis of dental origin is suspected Recurrent sinusitis (>3 attacks in a year) or chronic sinusitis (duration of illness of >12 weeks)