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Acute sinusitis — DCH MCQ

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HardCommon childhood illnessesAcute sinusitisDCH

An otherwise healthy 12-year-old girl has had purulent nasal discharge, bilateral facial pressure and cough for 12 days without improvement after a cold. She has no fever, severe unilateral facial or dental pain, or marked deterioration after initial improvement. She is systemically well, with normal vision and eye movements, no periorbital swelling and no neurological features. What is the most appropriate initial management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Recommend self-care, consider 14 days of high-dose intranasal corticosteroid, and safety-net without immediate antibiotics

Explanation lettering: E = shown as A · D = shown as C · C = shown as D · A = shown as E

D is correct. For acute sinusitis lasting around 10 days or more without improvement, NICE supports no immediate antibiotic or a back-up prescription. In children aged 12 years or over, a 14-day course of high-dose intranasal corticosteroid may also be considered; this use is off-label. Parents should be told that symptoms commonly last 2–3 weeks and should seek review for rapid or significant worsening, systemic illness, complication features, or failure to improve by 3 weeks. CT is not routinely required. Immediate co-amoxiclav is inappropriate in a well, low-risk child and is not routine first-line therapy. Nasal decongestants have limited supporting evidence and should not be continued for 14 days. Hospital treatment is reserved for severe systemic, orbital or intracranial complications.

Reference: NICE, Sinusitis (acute): antimicrobial prescribing (NG79), recommendations 1.1.4–1.1.9, published 2017 with update information amended May 2026. https://www.nice.org.uk/guidance/ng79/chapter/Recommendations