Online Acute Sinusitis Treatment

Some adults with uncomplicated acute sinusitis can be assessed online. The clinician will review how long symptoms have been present, facial pain or pressure, nasal discharge, fever, whether symptoms initially improved then worsened, allergies, pregnancy status, medical history and current medicines.

Severe systemic illness, significant eye swelling or visual symptoms, severe frontal headache, neurological symptoms or suspected complications require urgent face-to-face assessment.

No. Most acute sinusitis is viral and improves without antibiotics. NICE advises that antibiotics are generally not offered when symptoms have been present for around 10 days or less. Even when symptoms last longer, an immediate antibiotic is not always needed.

Antibiotics may be considered when symptoms have persisted for around 10 days or more without improvement and features suggest a bacterial cause, or where the person is at higher risk of complications. The decision depends on the whole clinical picture rather than symptom duration alone.

If you are systemically very unwell, have signs of a more serious illness or are at high risk of complications, you may need urgent face-to-face assessment and a different antibiotic pathway. NICE lists co-amoxiclav as first choice in these higher-risk situations rather than routine uncomplicated treatment.

Acute sinusitis is inflammation of the lining of the nose and sinuses, usually following a viral upper respiratory infection. It can cause nasal blockage, facial pressure, reduced smell and nasal discharge.

Symptoms can include blocked or congested nose, nasal discharge, facial pain or pressure, reduced sense of smell, headache, tooth discomfort, cough and sometimes fever.

NICE advises that the usual course of acute sinusitis is around 2 to 3 weeks. Symptoms lasting several days do not by themselves mean that antibiotics are required.

A bacterial cause becomes more likely when several features are present together, such as symptoms lasting more than 10 days, purulent nasal discharge, severe localised one-sided pain, fever or a marked deterioration after an initially milder phase of illness.

Phenoxymethylpenicillin, also called penicillin V, is the first-choice oral antibiotic in NICE guidance for uncomplicated acute sinusitis when an antibiotic is considered appropriate.

NICE lists Phenoxymethylpenicillin 500 mg four times daily for 5 days for adults with acute sinusitis when antibiotic treatment is appropriate.

Phenoxymethylpenicillin is unsuitable for people with a serious penicillin allergy and may require additional review in some medical situations. Your allergy history and previous reactions should be checked before prescribing.

Possible effects include nausea, diarrhoea and abdominal discomfort. Seek urgent help for symptoms of a serious allergic reaction such as difficulty breathing, swelling of the face or throat or widespread blistering rash.

Doxycycline is an alternative first-choice antibiotic in NICE guidance for adults with penicillin allergy or intolerance who are not pregnant.

NICE lists 200 mg on the first day, followed by 100 mg once daily for the next 4 days, giving a 5-day course in total.

Take Doxycycline with plenty of water while sitting or standing and avoid lying down immediately afterwards. Follow the dispensing label and patient information leaflet carefully.

Yes. Doxycycline can cause photosensitivity. Use appropriate sun protection and avoid excessive sunlight or sunbeds while taking it.

Doxycycline is not used as the routine penicillin-allergy alternative in pregnancy. NICE recommends erythromycin when a macrolide is needed during pregnancy and the benefits of antibiotic treatment outweigh the risks.

Clarithromycin is another alternative first-choice antibiotic in NICE guidance for adults with penicillin allergy or intolerance when it is otherwise clinically suitable.

NICE lists Clarithromycin 500 mg twice daily for 5 days.

Clarithromycin has clinically important interactions with several medicines and may be unsuitable in some people with heart rhythm problems or significant liver or kidney disease. A medication and medical-history review is required.

Possible effects include nausea, abdominal discomfort, diarrhoea and altered taste. Seek urgent medical advice for a serious allergic reaction, fainting, severe palpitations or significant persistent diarrhoea.

Most acute sinusitis is caused by viral infection and gets better without antibiotics. Antibiotics provide limited benefit for many people and can cause side effects and contribute to antimicrobial resistance.

NICE advises that for people aged 12 years and over with symptoms for around 10 days or more without improvement, a high-dose nasal corticosteroid for 14 days may be considered. This depends on individual suitability and other steroid medicines being used.

Paracetamol or ibuprofen may help pain or fever if they are suitable for you. Follow the product directions and consider your other medicines and medical conditions before taking them.

Decongestants may provide temporary relief of nasal blockage for some people but do not treat the underlying infection. Topical decongestants should not be used for prolonged periods because rebound congestion can occur.

There is limited evidence that steam inhalation meaningfully shortens acute sinusitis. Avoid very hot steam because of the risk of burns.

If an antibiotic is prescribed, symptoms should begin to improve over the following few days. Seek reassessment if symptoms worsen rapidly or significantly, or if there is no meaningful improvement after the course or after several days of treatment.

Take the antibiotic exactly as prescribed and complete the course unless a healthcare professional tells you to stop. Do not save leftover antibiotics for a future illness.

NICE advises reassessment when symptoms worsen despite first-choice treatment. A different diagnosis, complication or second-choice antibiotic may need to be considered rather than simply continuing unchanged.

Yes. Some people experience recurrent episodes, particularly with allergy, nasal polyps or other nasal conditions. Recurrent or persistent symptoms may need GP or ENT assessment rather than repeated antibiotic courses.

Urgent assessment is needed for swelling around the eye, double vision, reduced vision, difficulty moving the eye, severe frontal headache, swelling over the forehead, neurological symptoms, meningism, severe systemic illness or suspected sepsis.

Sinus infection can rarely spread into the tissues around the eye or orbit. Eye swelling, painful or restricted eye movements, double vision or reduced vision requires urgent assessment because vision-threatening complications can occur.

A severe frontal headache, particularly with forehead swelling, confusion, neck stiffness or neurological symptoms, can indicate a rare intracranial or frontal-bone complication and requires urgent medical assessment.

Pregnancy and breastfeeding should be disclosed before treatment. Antibiotic selection differs in pregnancy, particularly where there is penicillin allergy. The prescriber will choose an appropriate option based on the individual situation.

Significant immune suppression increases the risk of complications and may change the assessment and treatment pathway. A lower threshold for face-to-face medical review is appropriate.

Repeat antibiotic courses should not be supplied automatically. Recurrent, persistent or treatment-resistant symptoms require reassessment to confirm the diagnosis and consider other causes or specialist review.

If antibiotic treatment is clinically appropriate, it will be dispensed with directions for use and relevant patient information. Follow the dispensing label and leaflet carefully and seek review if red-flag symptoms develop.