Acute sinusitis
ACUTE SINUSITIS
ELIGIBILITY:1 Adults and children aged 12 years and over
EXCLUDE: Immunosuppressed individuals, chronic sinusitis (causes symptoms that last for more than 12 weeks), pregnant individuals under 16 years
SINUSITIS (sinus infection) is inflammation of the sinuses and nasal cavity. It is usually self-limiting and often triggered by a viral infection such as a cold. In fact, only 2% of cases are caused by a bacterial infection, so antibiotics are rarely used as treatment.1,4,5 There are some signs to help determine if the cause is bacterial and if the customer may be suitable for the Pharmacy First service.
Jason, a 35-year-old male, approaches the counter, asking to purchase another pack of pseudoephedrine tablets for his blocked sinuses. You remember speaking to him about this last week and consider that he may be suffering from sinusitis.
Jason says he is not feeling well. You ask him a few more questions about his symptoms to establish if he is suitable for the Pharmacy First service and to rule out any red flags.
Jason presents with the following signs and symptoms of sinusitis:4
Pain, swelling and tenderness around the cheeks, eyes and forehead
Blocked nose
Runny nose
Reduced sense of smell
Swollen neck glands (tonsils)
Green or yellow mucus from the nose
Fever
Jason shows all the signs and symptoms of sinusitis; however, it can be difficult to distinguish between viral and acute bacterial sinusitis. The Pharmacy First service is only available for those suffering with bacterial sinusitis. A bacterial cause may be more likely if several of the following symptoms are also present:5
Symptoms for more than 10 days
Discoloured or purulent (containing pus) nasal discharge
Severe, localised one-sided pain (particularly over the teeth and jaw)
Fever
Worsening over time
Jason does not appear to have any red flag symptoms that would require emergency referral:1,5
Reduced vision
Swelling over the frontal bone (forehead)
Severe headache
Reduced consciousness
Signs of sepsis
Click the button to find out whether this customer is eligible for referral.
REFERRAL OUTCOME
Referred to the Pharmacy First service
Jason’s sinusitis is likely caused by a bacterial infection, means that he may be eligible for the Pharmacy First service. You explain:
"Purchasing another pack of pseudoephedrine may not be the best option as treatment. Your symptoms suggest that you may have sinusitis which is one of the conditions covered by the Pharmacy First service. Would you like to speak with the pharmacist who can assess this further?"
Jason agrees and the pharmacist completes the consultation which leads to him receiving antibiotic treatment. Think about self-care advice you can provide and products you can recommend that he can use alongside his treatment.
SELF-CARE ADVICE
To help his sinusitis symptoms, you could advise Jason to:4
Get plenty of rest
Stay hydrated by drinking plenty of fluids
Avoid allergens, e.g. pollen or pet dander
Don’t smoke
As he has a fever and does not feel well, he should stay home and avoid contact with others until his health improves
OTC PRODUCTS
Jason can use some products to help relieve the discomfort of sinusitits:4,5
Paracetamol or ibuprofen may be useful to relieve pain and lower his temperature
Salt water nasal sprays or solutions can help to clean the inside of the nose
Nasal decongestant sprays and drops can be considered to help unblock the nose
To ensure suitability, you should always speak with the pharmacist if the customer is taking any medication (including those provided in the Pharmacy First service) or has any other medical conditions.
Complete the care
Jason tells you that medicated nasal sprays are not suitable for him; however, he will follow the self-care advice and take some paracetamol for the pain. You do not sell Jason the pseudoephedrine tablets that he originally requested, but advise him to come back if he has any other questions or if his symptoms worsen.
KEY LEARNING POINT
If Jason had been sold the medicine he asked for without further questioning, his bacterial infection may have been undetected which could have resulted in his condition worsening. When advising customers, it’s important to consider if Pharmacy First may be a suitable service to determine the best course of action.