7.3 Sinusitis

Type of Infection	First Line (with Dosage and Duration)	Alternative First Line (with dosage and Duration)	Comments
Patient-haemodynamically stable	Most commonly it is viral in etiology and hence not required to treat with antibiotics, unless signs of bacterial infection are present like: new onset fever after initial improvement or facial pain or purulent discharge, in that case treat like complicated sinusitis as mentioned below		Symptoms for 10 days or less: no antibiotic required. Systemically very unwell or high risk of complications: immediate antibiotics. Indications for antibiotics: A. Signs/symptoms >10 days without improvement. B. fever>39[102], purulent nasal discharge, facial pain>3 days from beginning. C. double sickening {worsening of symptoms at 5 to 6 days after initial improvement}.
Complicated sinusitis (Patient with acute onset high fever with facial pain or purulent nasal dischargewith orbital/ soft tissue cellulitis or cranialcomplication)	Amoxicillin 1000 mg q8h for 5-7 days Or Amoxicillin-clavulanate 1.2g IV q8h in adults for 5 -7 days Or Amoxicillin-clavulanate 1g BD PO	Cefixime 400mg BD for 7 days Or Doxycycline 100 mg q12h for 5-10 days
Suspicion of Fungal sinusitis	Treatment based on microbiological test reports		Scraping from middle meatus to be done for microscopy (KOH mount). Surgical debridement; treatment of comorbidities.

Type of Infection

First Line
(with Dosage and Duration)

Alternative First Line
(with dosage and Duration)

Comments

Patient-haemodynamically stable

Most commonly it is viral in etiology and hence not required to treat with antibiotics, unless signs of bacterial infection are present like: new onset fever after initial improvement or facial pain or purulent discharge, in that case treat like complicated sinusitis as mentioned below

Symptoms for 10 days or less: no antibiotic required. Systemically very unwell or high risk of complications: immediate antibiotics. Indications for antibiotics: A. Signs/symptoms >10 days without improvement. B. fever>39[102], purulent nasal discharge, facial pain>3 days from beginning. C. double sickening {worsening of symptoms at 5 to 6 days after initial improvement}.

Complicated sinusitis (Patient with acute onset high fever with facial pain or purulent nasal dischargewith orbital/ soft tissue cellulitis or cranialcomplication)

Amoxicillin 1000 mg q8h for 5-7 days

Amoxicillin-clavulanate

1.2g IV q8h in adults for 5 -7 days

Amoxicillin-clavulanate 1g BD PO

Cefixime 400mg BD for 7 days

Doxycycline 100 mg q12h for 5-10 days

Suspicion of Fungal sinusitis

Treatment based on microbiological test reports

Scraping from middle meatus to be done for microscopy (KOH mount). Surgical debridement; treatment of comorbidities.

For common etiological agents of Sinusitis, see Annexure B.7.3

Additional Information

Steam inhalation is advised for alleviation of symptoms