Title Acute rhinosinusitis.pdf ✅

Version: 11 June 2024 National Antimicrobial Guideline, 4th Edition (2024) Clinical Pathways for Primary Care: Acute Rhinosinusitis Check for likely ABRS (≥ 3 of the following): - Fever >38°C - Discoloured mucus - Double sickening - Severe local pain - Raised ESR/CRP Suspected acute rhinosinusitis Sudden onset of nasal obstruction or Nasal discharge (anterior/posterior nasal drip) with ± Facial pain or pressure ± Reduction or loss of smell Sudden onset is defined as symptoms lasting <12 weeks, with a symptom-free interval in the case of recurrent episode If symptoms persist continuously ≥12 weeks (without symptom free interval), for immediate referral to ENT Likely ABRS Check if ≥3 episodes of ABRS per year Refer to secondary/tertiary care Consider antibiotics No other investigations Check duration of current episode Acute viral rhinosinusitis Acute post-viral rhinosinusitis Improvement after antibiotics Recommended dosage (adults) Antibiotics Dosing Duration Remarks Amoxycillin 500-1000mg PO q8h 5 days Preferred Amoxycillin / Clavulanate 625mg PO q8h 5 days Preferred Doxycycline 100mg PO q12h 5-7 days Alternative 1. The WHO AWaRe (Access, Watch, Reserve) antibiotic book 2022. 2. European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020. No Yes No No Yes PRESENCE OF ALARM SYMPTOMS (IMMEDIATE REFERRAL) Periorbital oedema/erythema Severe headache Displaced globe Frontal swelling Double vision Signs of sepsis Ophthalmoplegia Signs of meningitis Reduced visual activity Neurological signs Algorithm adapted from European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2020. ARS, acute rhinosinusitis; ABRS, acute bacterial rhinosinusitis Double sickening – significant worsening of symptoms after initial mild phase. Duration of ARS symptoms <10 days Increase ARS symptoms after 5 days or Persistent ARS symptoms > 10 days Yes Symptomatic treatment Avoid antibiotics End