Sinusitis Treatment
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Sinusitis
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Before you start a diagnosis, please read all of the information below.
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Acute sinusitis is a common condition caused by inflammation of the sinuses and is also usually associated with inflammation of the nasal passages (rhinitis). There are 4 groups of sinuses which are hollow cavities in the facial bones around the nose and these drain into the nasal passages. These are called the frontal, maxillary, sphenoidal and ethmoidal sinuses.
80% of sinusitis cases will resolve within 14 days without antibiotics, therefore it is generally advised to use over-the-counter (OTC) medication as first-line treatment from your pharmacy.
If your symptoms are worsening or not improving within this duration then we may prescribe antibiotics if clinically appropriate.
Please see Common Treatments below for further information.
Symptoms that you may experience include:
- pain and tenderness around the sinus areas (in the cheeks, around the eyes and the forehead)
- a runny nose
- sneezing
- a blocked nose
- a mild headache
- a 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 to 10 days.
Most sinus infections are viral, do not require antibiotics, and will improve within a week on their own. The usual course of acute sinusitis lasts 2 to 3 weeks. 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. If your symptoms are worsening despite self-care methods then you can either contact your local GP, call NHS 111 for help, or Start a Diagnosis with i-GP.
Possible treatments we prescribe if clinically appropriate:
- Phenoxymethylpenicillin 500mg Four times a day: 5-day course (£1.60)*
- Doxycycline 100mg Two Immediately Then One A Day: 7-day course (£0.70)*
- Clarithromycin 500mg Twice a day: 5-day course (£1.97)*
*Prices shown are the cost price of the medication, taken from the British National Formulary 2018, and are given as a guideline. Pharmacies will add a dispensing fee to this which will vary considerably, so it is worthwhile phoning around to compare prices. The medication is paid for at your chosen pharmacy.
Please click on the medication above to read the Patient Information Leaflet for important information about each drug. We use national prescribing guidelines to select which treatment would be most appropriate for your condition.
How do we select which treatment we will prescribe?
This will depend on your symptoms. If you have symptoms that would benefit from a physical assessment instead, you will be signposted to appropriate services for free. The doctor will assess from your digital consultation whether your symptoms would benefit from an antibiotic or whether self-care care would be most appropriate for your condition.
If your symptoms show that you may benefit from an antibiotic in your digital consultation, then the first line antibiotic for Acute Sinusitis that we prescribe is Phenoxymethylpenicillin. If you are allergic to penicillins, or if your medical conditions make Phenoxymethylpenicillin unsuitable for you, the second line antibiotic is usually Clarithromycin. An alternative is Doxycycline if the other two antibiotics are unsuitable. If you have any queries or concerns about the antibiotic choice, then please tell us in the additional information box during your digital consultation.
Acute sinusitis is usually caused by a viral infection, bacteria or an allergy. The infection starts after something blocks the opening to the sinuses, most commonly caused by a viral infection such as a cold.
During a cold, the mucous membranes (lining) of the nasal passage tend to block the opening of the sinuses. The air that usually fills the sinuses is absorbed into the bloodstream, and the pressure in the sinuses reduces, drawing fluid into the sinuses and causing pain. This fluid then may become a breeding ground for bacteria.
Your white cells (immune cells) and more fluid enter into the sinuses to fight the bacteria. This increase in fluid then causes the pressure to increase in the sinuses resulting in more pain. The infection, however, will often remain viral before clearing. It can less frequently become bacterial, where bacteria add on to the infection caused initially by a virus. This tends to cause the symptoms to become worse and to last longer.
Infrequently the infection may spread from a dental abscess to the sinus in the cheekbone (maxillary sinus).
Some circumstances may increase a person's chances of developing sinusitis. These include:-
- Nasal Allergy
- Nasal Polyps
- Previous facial trauma or surgery
- Deviated nasal septum
- Asthma
- Poor immune system
- Pregnancy
- Smoking
There are certain treatments you can try at home which may help you to manage your symptoms.
Pain medication:
- such as paracetamol or ibuprofen. Read the leaflet that comes with the medication to check its suitability. This can help with the sinus pain and fever.
Over-the-counter Decongestant nasal sprays or drops:
- these may help with a blocked nose to allow you to breathe through it better. Check with the pharmacist first to ensure they are suitable for you. Do not use them for more than a week.
Saline (salt water) nasal drops:
- can help reduce the nasal discharge and unblock your nose.
Warm face packs:
- may help ease the sinus pain and help drain the mucus.
Drinking plenty of water to keep hydrated.
When to seek further medical advice
If your symptoms worsen quickly or significantly, or do not improve after 3 weeks then seek further medical advice.
Alternative treatments to antibiotics
A high dose nasal steroid can be prescribed for 14 days if your symptoms have lasted around 10 days or more with no improvement. Nasal steroids may help improve symptoms but are not likely to affect how long they last.
Phenoxymethylpenicillin is sometimes prescribed for acute sinusitis.
Do not take Phenoxymethylpenicillin if you are allergic to penicillin.
Before you start the treatment read the manufacturers leaflet contained with the medication, which contains more information and the potential side effects.
The dose is to be taken four times a day, it is important that you space out the doses evenly during the day. Swallow the tablet with water, and you should take phenoxymethylpenicillin on an empty stomach. Take your dose one hour before you eat any food, or wait until two hours afterwards. This is because your body absorbs less of the medicine after a meal, which means it is less effective.
Most types of medicines can cause potential side effects. However, not everyone will experience them. The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then contact us, or speak with your doctor or pharmacist.
The most common ones for phenoxymethylpenicillin (occur in about 1 in 10 people) include:
- Feeling sick (nausea) or vomiting
- Diarrhoea
- Redness and itching in the mouth or vagina (thrush)
- Skin rashes
If you develop a skin rash then it is important you speak to a doctor as soon as possible.
Clarithromycin is sometimes prescribed for acute sinusitis, it is used if you have an allergy to penicillins.
Always read the manufacturers leaflet contained with the medication. This contains more information and lists all the potential side effects.
The dose is to be taken twice a day. It is important that you space out the doses evenly during the day. Swallow the tablet with water and you can take it either before or after food.
Keep taking Clarithromycin until the full course is finished (unless a doctor tells you to stop), even if you feel that the infection has cleared up. This is to stop the infection from coming back. If you forget to take a dose, take one as soon as you remember unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.
Most types of medicines can cause potential side effects. However, not everyone will experience them. The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then contact us, or speak with your doctor or pharmacist.
The most common ones (occur in about 1 in 10 people) for Clarithromycin include:
- feeling sick (nausea) or vomiting
- diarrhoea
- redness and itching in the mouth or genital area (thrush)
- tooth or tongue discolouration, and changes in the way things taste or smell. This will settle once you finish treatment
- a headache
It is important that you tell your doctor in your assessment of all the medical conditions you have, and all the medications you take. Failure to do so can lead to problems with any treatment you are prescribed. Always read the patient leaflet before you take any medication.
The following groups of people should not take Clarithromycin:
- those allergic to clarithromycin or macrolide antibiotics
- those with QT prolongation or ventricular cardiac arrhythmia, including torsades de pointe
- those with heart disease
- those with hypokalaemia (low potassium)
- those with problems with the way your liver works
- pregnant women or if breastfeeding
The following medications can interact with Clarithromycin:
- Statin for lowering cholesterol: you should stop your statin while you are taking Clarithromycin.
- Colchicine used for gout: clarithromycin should not be taken if you are also taking colchicine.
- Warfarin: Clarithromycin can increase the bleeding risk
- Ergotamine or dihydroergotamine used for migraines: Clarithromycin must not be taken with them
- Sildenafil, tadalafil or vardenafil: Clarithromycin can increase the levels of the erectile dysfunction (ED) medication in the body. Consider reducing the dose of the ED medication while taking Clarithromycin.
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 investigations.
- 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
- a severe headache
- drowsiness or confusion
- persistent vomiting
- neck stiffness
- non-blanching rash
In an emergency call 999 for immediate help for life-threatening conditions.
During working hours you can contact your GP surgery for help or call NHS 111. Alternatively, the following links can help you find Urgent Care Centres or Out of Hours care near you:
England
Website: NHS Choices or telephone NHS 111
Wales
Website: NHS Direct Wales or telephone NHS Direct Wales on 0845 46 47 or the new 111 Wales Service for Swansea Neath Bridgend & Carmarthen
Scotland
Website: NHS Inform or call NHS 111
Northern Ireland
Website: Health and Social Care
The contact telephone numbers for out of hours GP services in your area can be found here: NI Direct Government Services
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.
Learn more about Periorbital Cellulitis
An itchy rash, swollen face or mouth, or difficulty in breathing, may be signs that you are allergic to the medication.
Please note that i-GP DOES NOT TREAT Medical Emergencies.
If you develop a sudden onset of any of the symptoms below then you must STOP the medication immediately and seek urgent medical advice. This could be from your GP, Out of Hours Service, Urgent Care Centre or NHS 111. Call an ambulance or go to A&E if the symptoms are severe.
- Wheeze
- Difficulty in Breathing
- Swelling of the eyelids, face or lips
- A rash particularly if affecting your entire body
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.
Acute Sinusitis: www.patient.info
Acute Sinusitis: NICE CKS, October 2013
