Sinusitis

Clinical Description

Sinusitis is inflammation of one or more paranasal sinuses. Predisposing risk factors are nasal obstruction from allergic rhinitis/polyp, dental infection/dental extraction, fractures involving sinuses, swimming in dirty waters. Mainly caused by virus (common cold) hence self- limiting. It can also be caused by Bacterial (group A haemolytic streptococci, S.

Pneumoniaea, S. aureus H.influenzae, M.catarrhalis).

Signs and Symptoms

• Cough and nasal congestion (allergy symptoms)
• Postnasal drip symptoms (throat irritation and throat clearing cough)
• Fever/purulent and foul-smelling nasal discharge and halitosis (if bacterial)
• Frontal headache/pressure in the face
• Tenderness on sinuses area
• If severe may have facial/periorbital swelling and fever

Investigations

• Usually none needed unless complicated sinusitis not responding to treatment (may consider full blood count, parasinuses x-ray/CT scan)

Non-pharmacological

• Most sinusitis is viral and self-limiting, requiring no antibiotics
• Steam inhalation may help drainage of blocked sinus

Pharmacological

• Analgesia if pain/headache: Paracetamol 1g 6 hourly or Ibuprofen 400mg 8 hourly

PO or other (adult);

• Antibiotic if signs of bacterial sinusitis:

Adult

• Amoxicillin 500mg 8 hourly for 7 days or Amoxicillin-clavulanic acid 625mg 8 hourly or Cefuroxime 250 to 500mg 12 hourly PO (alternatively Erythromycin 500mg 6 hourly or Azithromycin 500mg daily for 5 days if penicillin hypersensitivity)

Children

• 6-12 years: Amoxicillin: 250 mg 8 hourly for 7 days
• 1-5 years: 125 mg 8 hourly for 7 days
• < 1 year: 62.5 mg 8 hourly for 7 days

Alternatively, Amoxycillin 15mg/kg 8 hourly for 7 days

Or

Amoxicillin + Clavulanic Acid:

• 6-12 years; 400/57 mg 8 hourly for 7 days
• 1-6 years: 200/28.5 mg 8 hourly
• 1 month-1 year: 200/28.5 mg 8 hourly

Cefuroxime:

• 3 months-12 years: 125 mg 12 hourly, double in severe infection.

Erythromycin: 2-8 years: 250 mg 6 hourly for 7 day

• 1 month-2 years: 125 mg 6 hourly

Alternatively, Erythromycin 10mg/kg 6 hourly for 7 days

Neonate: Erythromycin 12.5 mg/kg 6 hourly Or Azithromycin: 10 mg/kg daily for 5 days

• Sinusitis prevention for patient undergoing tooth extraction Benzathine Penicillin 1.2g IM stat or Amoxycillin 3g orally stat 1hour prior to procedure a n d

Metronidazole 400mg)

Complications of sinusitis

• Periorbital swelling
• Dental abscess

Note: Patients with complications need referral to a specialist 16.1. 4 PHARYNGITIS AND TONSILLITIS

Most sore throats are due to viral infections such as adenovirus and CMV and should not be treated with antibiotics. For pain or fever give analgesic treatment as required, be sure to rule out streptococcal pharyngitis to prevent acute rheumatic fever and other non- suppurative (endocarditis) and suppurative complications (retropharyngeal and peritonsillar abscesses).

Signs and Symptoms

• Abrupt onset of pain
• Fever,
• Tender,
• Enlarged cervical lymph nodes,
• White or greyish pharyngeal exudates,
• Absence of lower respiratory tract signs and symptoms
• Absence of signs suggesting viral nasopharyngitis (e.g. Rhinorrhoea, Conjunctivitis, Cough)

Pharmacological

Adults

• Give Benzathine Penicillin 1.2 MU single dose IM
• Alternatively (if assured of compliance)
• Give Amoxycillin 500mg 8 hourly for 7 days
• Alternatively in penicillin hypersensitive patients:
• Give Erythromycin 500mg 6 hourly for 7 days

Children

• Give Benzathine Penicillin 0.6MU if <30kg or 1.2 MU >30kg single dose IM
• Alternatively (if assured of compliance)
• Give Amoxycillin 15mg/kg 8 hourly for 7 days
• Alternatively in penicillin hypersensitive patients:
• Give Erythromycin 10mg/kg 6 hourly
• OR
• Azithromycin 10mg/kg daily for 5 days

Note:

• Do not use cotrimoxazole as it is not effective
• If there is pain or fever give analgesic treatment as required