Suspected acute rhinosinusitis:

Presence of ≥2 symptoms one of which should be

nasal obstruction or purulent / greenish nasal discharge
±facial pain, headache
±smell disturbance
Examination: anterior rhinoscopy

Symptoms increasing after 5

Symptoms <5 days or
days or persistent after 10
improving thereafter
days

Mild Moderate Severe

Common cold
VAS = 0 to 3* VAS 4 to 7* VAS 8 to 10*

Symptomatic relief Symptomatic relief

Symptomatic relief
Treat accordingly medication** medication**
medication**
+ Topical steroid + Topical steroid
+ Consider
antibiotic***
No improvement after 10 days or
worsening after 5 days

Improvement within 3 days

Topical steroid
e.g. Budesonide nasal spray
No Yes

Continue
No improvement after 14 days
Refer to specialist treatment 7-14
treatment
days

* Severity of disease can be based on Visual

Analogue Score (VAS). The patient is asked: Recommended dosage
“How troublesome are your symptoms”
Not troublesome (0) to Worst thinkable
Antibiotics Dosing Duration Remarks
troublesome (10) Amoxicillin 500mg tds 5-7 days Preferred
** May include analgesics, nasal saline Augmentin 500/125mg tds 5-7 days Preferred
irrigation & decongestants
Erythromycin 250-500mg bd 5 days Alternative
*** At least 3 of:
- purulent/greenish nasal discharge Doxycycline 200mg stat D1 5 days Alternatives
- severe local pain then
- fever 100mg od D2-5
- elevated ESR/CRP
- double sickening (becoming worse again 1. Clinical Practice Guidelines, Management of Rhinosinusitis in
after initial recovery) Adolescents and Adults 2016, MOH/P/PAK/318.16(GU).
2. Sinusitis (Acute): Antimicrobial Prescribing. NICE Guideline 2017