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Sinusitis

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The sinuses are several small spaces within the face centred around the cheekbones and forehead. They produce fluid which normally drains into the nose.

Sinusitis means there is an inflammation of the sinus and most episodes are caused by infection and often follows a cold.

80% of cases will resolve within 14 days without antibiotics, so antibiotics are not usually needed.

Unnecessary use of antibiotics may cause side effects and may increase the incidence of antibiotic resistance.

Please visit the following NHS site for further information regarding the condition:

nhs.uk/Conditions/Sinusitis/Pages/Introduction.aspx


Common Symptoms

Common Symptoms

  • Pain and tenderness around the sinus areas (in the cheeks, around the eyes and the forehead)
  • Runny nose
  • Sneezing
  • Blocked nose
  • Mild Headache
  • Low Grade Fever
  • Congestion
  • Loss of smell

Most symptoms are at their worst after 2 to 3 days then will gradually start to improve usually within 7- 10 days. 

Common Treatments

Most Sinus Infections are viral, do not require antibiotics, and will improve within a week on their own. Common treatments for the symptoms include paracetamol, ibuprofen, and decongestants which can help with the pains and fever. You can seek further advice about such over the counter treatments from your local pharmacy.

Possible treatments we prescribe if clinically appropriate:

  • Amoxicillin 500mg Three Times Daily - 7 Day Course £1.57
  • Doxycycline 100mg Two Immediately Then One A Day - 7 Day Course £1.07

Prices shown are cost price of the medication, taken from the British National Formulary 2016, and are given as a guideline. Pharmacies will add on a dispensing fee to this which will vary considerably, so it is worthwhile phoning around to compare prices.

Symptoms unsuitable for i-GP

There are certain symptoms that may be present with an episode of Acute Sinusitis that suggests you should see a doctor in person, as soon as possible, for a physical assessment and you may require further investigation.

  • Severe pain and/or swelling affecting your forehead
  • Swelling or redness around the eye or swelling of the face
  • Visual problems
  • Blood-stained discharge coming from the nose

If you develop any of the following symptoms, then you must seek urgent medical advice immediately (from your GP, Out of Hours Service, Urgent care centre, NHS 111) or call an ambulance if the symptoms are severe:-

  • Difficulty in breathing
  • Chest pain
  • Severe headache
  • Drowsiness or confusion
  • Persistent vomiting
  • Neck stiffness
  • Non-blanching rash
When to seek further advice

If your symptoms become severe, you develop a high fever or do not ease within a week then to seek further medical advice.

It may, however, take up to 2-3 weeks for the symptoms to completely settle.

Complications

Serious complications of Acute Sinusitis are rare and occur in around 1 in 10,000 people with the infection. Examples of complications include infection spreading from a sinus to around an eye, into bones, into the blood, or into the brain. 

Amoxicillin Information

Do not take Amoxicillin if you are allergic to penicillin.

Please fully read the Patient Information Leaflet that comes with the medication before starting treatment. 

This will contain more comprehensive information and a full list of side effects. 

How to take Amoxicillin

These capsules may be taken before, during or after your meals.

Remember to finish the course as prescribed.

 

Allergic Reactions

An itchy rash, swollen face or mouth, or have difficulty breathing, these may be signs that you are allergic to the antibiotic. 

Please note that i-GP DOES NOT TREAT Medical Emergencies. 

If you develop any sudden onset of the following then you must STOP the medication and seek urgent medical advice (from your GP, Out of Hours Service, Urgent care centre or NHS 111) or call an ambulance if the symptoms are severe:-

  • Wheeze
  • Difficulty in Breathing
  • Swelling of the eyelids, face or lips
  • A rash particularly if affecting your entire body

Possible Side Effects

All medications have the potential to cause side effects, but not everyone experiences them. The most common ones include

  • Feeling sick (nausea) or vomiting
  • Diarrhoea
  • Redness and itching in the mouth or vagina (thrush)
  • Skin rashes
Doxycycline Information

Please fully read the Patient Information Leaflet provided with the medication, before starting treatment. 

This will contain more comprehensive information and a full list of side effects. 

How to take Doxycycline

You should not drink alcohol while taking Doxycycline capsules.

Do not take indigestion remedies, or supplements containing iron, magnesium, or zinc at the same time as doxycycline as they stop it from working properly.

Swallow the capsules whole with a full glass of water, if the capsules irritate your stomach take them with food or milk while either sitting down or standing up. Take them well before you go to bed for the night to stop irritation and ulceration of your gullet. It is important not to lie down for at least thirty minutes after taking Doxycycline capsules. 

Remember to finish the course as prescribed.

Driving and using machines 

Do not drive or use machines if you suffer from visual disturbances such as blurring of vision while taking Doxycycline. 

Allergic Reactions

Doxycycline can occasionally cause allergic reactions. An itchy rash, swollen face or mouth, or have difficulty breathing; these may be signs that you are allergic to the antibiotic. 

Please note that i-GP DOES NOT TREAT Medical Emergencies. 

If you develop any sudden onset of the following then you must STOP the medication and seek urgent medical advice (from your GP, Out of Hours Service, Urgent care centre or NHS 111) or call an ambulance if the symptoms are severe:-

  • Wheeze
  • Difficulty in Breathing
  • Swelling of the eyelids, face or lips
  • A rash particularly if affecting your entire body

Possible Side Effects

All medications have the potential to cause side effects, but not everyone experiences them. Doxycycline is well tolerated by most people but side effects include:

  • Stomach upset, indigestion, abdominal pain
  • Diarrhoea
  • Redness and itching in the mouth or vagina (thrush)
  • Dry mouth, throat irritation
  • Feeling anxious, increased sweating
  • A headache, other aches and pains

Stop taking the capsules immediately and seek urgent medical advice in the following circumstances:

  • Photosensitivity: if you notice that your skin is very sensitive to light (you may get a skin rash, itching, redness or severe sunburn when out in sunlight or after using a sun bed).
  • Severe skin reactions: this includes erythema multiforme (circular, irregular red patches), Stevens- Johnson syndrome (rash with flushing, fever, blisters or ulcers), toxic epidermal necrolysis (reddening, peeling and swelling that resembles burns).

Antibiotic Resistance

Antibiotics should be used responsibly and only when really necessary. Overuse and misuse of antibiotics can lead to antibiotic resistance. This is where the antibiotic becomes less effective at treating certain types of bacterial infection, so they do not work when needed. 

Antibiotics should be taken as prescribed, and it is important to complete the full course, this can reduce the chance of the bacteria developing an immunity to that antibiotic. It is important not to share antibiotics, and always take unused medication to your local pharmacy for disposal.

References

Acute Sinusitis: www.patient.info

Acute Sinusitis: NICE CKS, October 2013

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