Identifying sinusitis
Identifying sinusitis
You should use considered questions to determine whether your customer has sinusitis or another condition or infection, as symptoms may present similarly. In particular, you should be able to identify additional symptoms that could indicate a bacterial sinusitis infection. This will ensure that customers receive the treatment they need without unnecessary delay.
The Pharmacy First service may be considered for adults and children aged 12 years and over. The service excludes: immunosuppressed individuals, chronic sinusitis (sinusitis that causes symptoms that last for more than 12 weeks) and pregnant individuals under 16 years.3
Click on the flashcards below to learn more about the signs and symptoms of sinusitis and other conditions that may present similarly
1. Acute sinusitis (viral)3
Acute sinusitis is diagnosed by the presence of ONE of the following symptoms:
Nasal blockage (obstruction/congestion)
Nasal discharge (anterior/posterior nasal drip)
With ONE or more of the following symptoms:
Facial pain/pressure (or headache)
Reduction (or loss) of sense of smell (in adults)
Cough during the day or at night (in children)
If your customer has had these symptoms for 10 days or less, it will most likely indicate a viral sinusitis infection. Most viral cases last between 2-3 weeks. If your customer does NOT have these symptoms, a differential diagnosis should be considered.
2. Acute sinusitis (bacterial)3
The customer would present with symptoms aligned with those of acute sinusitis, alongside TWO or more of the following symptoms:
Marked deterioration after an initial milder phase
Fever (>38°C)
Constant discoloured nasal discharge
Severe localised unilateral pain, particularly pain over the teeth (toothache) and jaw
If your customer has these symptoms for more than 10 days with no improvement, and they meet the eligibility criteria, they may be suitable for treatment via the Pharmacy First service. Pending a shared decision making approach and the severity of the customer’s symptoms, various treatment options will be considered.
3. Differential diagnosis4
It is important to consider possible alternative diagnoses so that your customer receives the correct treatment. If your customer does NOT have symptoms indicating acute sinusitis, you could consider the following diagnoses that may present similarly:
Allergic rhinitis
Upper respiratory tract infection
Nasal polyps
Foreign bodies in the nose
Rebound congestion after stopping decongestant medication
If symptoms worsen rapidly or significantly at any time, your customer should be referred to their GP or A&E, as appropriate.3
Treating sinusitis
If your customer is eligible for the Pharmacy First service and meets the criteria (subject to inclusion/exclusion criteria in the PGD) they will be offered treatment.
Pharmacy First treatment for acute sinusitis
If your customer has symptoms of acute sinusitis, has had symptoms for more than 10 days but does NOT have 2 or more symptoms that indicate a bacterial infection, a shared decision-making approach based on the severity of the symptoms should be taken. Based on this, your customer could be offered a high dose nasal corticosteroid (off-label) for 14 days. The customer will be asked to return to the pharmacy if their symptoms do not improve in 7 days for pharmacist reassessment.3
If your customer has symptoms of acute sinusitis, has had symptoms for more than 10 days and has 2 or more symptoms that indicate a bacterial infection, a shared decision approach based on the severity of the symptoms will be taken. Based on this your customer could be offered a high dose nasal corticosteroid (off-label) for 14 days alongside self-care and pain relief, instead of antibiotics first line. However, if this is considered unsuitable or ineffective, antibiotics will be considered.3
Note: If symptoms do not indicate a bacterial infection, antibiotics make little difference to how long symptoms last or the number of people whose symptoms improve.3
Pharmacy teams must consider the risk of antimicrobial resistance which can occur with the inappropriate or overuse of antibiotics. Therefore, only eligible and suitable customers should be considered for antibiotic treatment.