Antibiotics

NICE advises that even bacterial sinusitis is usually self-limiting and does not routinely need antibiotics. A recently updated systematic Cochrane Review indicated only a small benefit from antibiotics even in acute sinusitis that had lasted for longer than seven days.

NICE says that antibiotics may be recommended if the symptoms of sinusitis persist for more than 10 days or are severe with fever (>38°C), severe local pain, discoloured or purulent nasal discharge or marked deterioration. NICE states that: “An immediate antibiotic prescription is not recommended unless people are systemically very unwell, have symptoms and signs of a more serious illness, or are at high risk of serious complications because of pre-existing comorbidity.”

Where an antibiotic is to be recommended NICE advises penicillin first-line unless there is a reported penicillin allergy via the NHS national care record or stated by the patient/carer.

Under the Pharmacy First scheme in England antibiotics via PGD can be provided by pharmacists where there are still persistent symptoms despite the use of high-dose nasal corticosteroid for 14 days, or if high-dose nasal corticosteroids are unsuitable. The antibiotics available to pharmacists to provide via PGD are penicillin-V (first line); with clarithromycin or doxycycline, or erythromycin in pregnancy, if penicillin allergy.

The main contraindication is allergy/hypersensitivity to an antibiotic – usually penicillin. Those with a known allergy to phenoxymethylpenicillin (penicillin-V), or any penicillin, or a history of severe immediate allergic reaction (e.g. anaphylaxis) to another beta-lactam antibiotic (e.g. cephalosporin, carbapenem or monobactam) must not be prescribed penicillin-V.