Bacterial Sinusitis

Clinical Description

This is an acute infection of the para-nasal sinuses. It may lead to complications with attendant morbidity and mortality. Early recognition of this clinical condition is mandatory.

Swimming in dirty waters, dental infection or dental extraction, fractures involving the sinuses, nasal obstruction from polyps and allergic rhinitis are predisposing factors to developing acute sinusitis.

Signs and Symptoms

• Purulent nasal discharge, persistent or intermittent, pain and tenderness over one or more sinuses, nasal obstruction, postnasal discharge, occasional fever.

Investigations

• FBC
• X-ray of paranasal sinuses
• 1. Sinusitis is uncommon in children under five years as sinuses are not fully developed
• 2. Unilateral foul-smelling nasal discharge is a foreign body until proven otherwise

Non-pharmacological

• Adequate hydration
• Steam inhalation

Pharmacological

Adults

• Give Oxymetazoline 0.05% 2 drops twice a day for not more than one week
• Give Cetirizine 10mg daily for 3-5 days
• Give Amoxycillin 500mg 8 hourly for 5 days
• Steam inhalations using Menthol are advised

Children

• Give Oxymetazoline 0.025% 2 drops twice a day for not more than one week
• Give Amoxicillin 25 mg/kg/dose in exacerbations of chronic sinusitis and HIV positive children who are on Cotrimoxazole prophylaxis.

Alternatively: penicillin hypersensitivity:

• Give Erythromycin 12.5 mg/kg/dose 6 hourly or Azithromycin 10mg/kg STAT then 5mg /kg daily for 7 day

If pain or fever:

• Give Analgesic/Antipyretic treatment as required

Complications and Referral Criteria

• No symptomatic relief after 48-72 hours of antibiotics
• CNS complications of sinusitis