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Bacterial Rhinosinusitis — MRCGP AKT MCQ

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EasyInfectious DiseasesBacterial RhinosinusitisMRCGP AKT

A 55-year-old man has had purulent nasal discharge and facial pain for 10 days without improvement. He is not systemically unwell, has no features of orbital or intracranial complications, and has no comorbidity increasing his risk of complications. What is the most appropriate initial management?

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Correct answer: A — Self-care and consideration of a high-dose intranasal corticosteroid for 14 days, with no antibiotic or a back-up prescription

The correct answer is A. In an otherwise well adult with acute sinusitis lasting around 10 days or more without improvement, NICE advises considering a high-dose intranasal corticosteroid for 14 days and either no antibiotic or a back-up prescription. Purulent discharge and facial pain increase the likelihood of a bacterial cause but do not, by themselves, mandate immediate antibiotics. Co-amoxiclav is reserved for patients who are systemically very unwell, have features of more serious illness, are at high risk of complications, or worsen despite first-choice treatment. Clarithromycin and doxycycline are alternatives when an antibiotic is indicated in someone with penicillin allergy or intolerance. Levofloxacin is not a NICE-recommended routine treatment for acute sinusitis.

Reference: NICE. Sinusitis (acute): antimicrobial prescribing, NG79, recommendations 1.1.4–1.1.8 and 1.2.1. 2017. https://www.nice.org.uk/guidance/ng79/chapter/Recommendations