Key facts

• Most cases of acute sinusitis take two to three weeks to resolve and do not need treatment with antibiotics – many patients will be unaware of this
• Most cases are caused by viruses – only two in 100 cases will be complicated by bacterial infection
• NICE advises that even bacterial sinusitis is usually self-limiting and does not routinely need antibiotics
• Self-care measures include use of analgesics and nasal saline irrigation
• Symptoms indicating bacterial infection are marked deterioration after an initial milder phase, fever (above 38˚C), unremitting purulent nasal discharge and severe unilateral pain (especially tooth and/or jaw pain)
• A high dose nasal corticosteroid, via a PGD, for 14 days (off-label) can be recommended in those who have had persistent unremitting symptoms for 10 days or longer
• Antibiotics, via a PGD, can be provided where there are still persistent symptoms despite the use of a high dose nasal corticosteroid, or if high dose nasal corticosteroids are unsuitable