Executive summary
- Timeline: Viral sinusitis lasts <10 days. Bacterial sinusitis is likely if symptoms >10 days.
- Key Intervention: High-dose nasal corticosteroids (Mometasone) are superior to antibiotics for symptom relief in many prolonged cases.
- Red Flags: Unilateral polyp, bleeding, orbital swelling/visual change, severe headache (intracranial spread). -> Urgent Referral.
Stepwise Management
- Symptoms < 10 days: Analgesia + Decongestants (max 1 week). Do not offer antibiotics.
- Symptoms > 10 days (or worsening after 5):
- 1. High-Dose Nasal Steroid: Mometasone 200mcg (2 sprays/nostril) bd for 14 days.
- 2. Delayed Antibiotic: If systemically unwell or high risk.
- 3. Immediate Antibiotic: Only if systemically unwell, severe pain, or purulent discharge >10 days.
Prescribing Choices
- First Line: Phenoxymethylpenicillin (Penicillin V)
- 500mg qds for 5 days.
- Second Line (or Allergy):
- Doxycycline: 200mg stat then 100mg od (5 days total).
- Clarithromycin: 500mg bd for 5 days.
- Co-amoxiclav: Reserved for systemically very unwell/failure.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.