Using the acute sinusitis PGDs

If the patient has passed the Gateway Point in the clinical pathway, and has two or more of the following symptoms, this suggests acute bacterial sinusitis: 

• Marked deterioration after an initial milder phase  
• Fever (>38˚C) 
• Unremitting purulent nasal discharge 
• Severe localised unilateral pain, particularly pain over the teeth (toothache) and jaw. 

If a bacterial infection is NOT indicated, offer self-care advice and pain relief. Depending on the severity of the symptoms, consider offering a high dose nasal corticosteroid: 

1. Fluticasone – in children aged 12 years and over and adults 
2. Mometasone – in children aged 12 years and over and adults.

If a bacterial infection IS suggested, and based on the severity of symptoms, offer as a first option a high dose nasal corticosteroid. If this is unsuitable or ineffective there are four antibiotic options: 

1. Phenoxymethlypenicillin – for individuals aged 12 years and over 
2. Clarithromycin – for individuals aged 12 years and over with reported penicillin allergy.  
3. Doxycycline – for individuals aged 12 years and over with reported penicillin allergy 
4. Erythromycin – for individuals aged 16 years and over who are pregnant, or where pregnancy is suspected, with reported penicillin allergy. 

Download our quick guide to using the sinusitis PGDs here.