What is the treatment for sinusitis based on UK Clinical Knowledge Summaries (CKS) guidance?

From the Guidelines

The treatment for sinusitis, particularly for chronic rhinosinusitis (CRS), should involve recommending saline nasal irrigation, topical intranasal corticosteroids, or both for symptom relief, as this approach has been shown to have a preponderance of benefit over harm 1.

Symptom Management

For patients with sinusitis, managing symptoms is a crucial aspect of treatment. This can include:

• Recommending paracetamol or ibuprofen for pain and fever management
• Using nasal saline irrigation to help clear mucus
• Considering topical intranasal corticosteroids for symptom relief in chronic cases

Antibiotic Use

Antibiotics should be reserved for cases where symptoms are severe, persist beyond 10 days, or worsen after initial improvement. The decision to use antibiotics should be made cautiously, considering the minimal benefit they offer for most cases of sinusitis and the risks of side effects. When necessary, the choice of antibiotic should be based on the most recent and highest quality evidence available.

Patient Education

Patients should be advised that sinusitis is usually self-limiting and that antibiotics offer minimal benefit for most cases. They should also be educated on the signs and symptoms that may indicate complications requiring urgent assessment, such as severe headache, orbital complications, or neurological symptoms.

Specific Treatment Recommendations

For chronic rhinosinusitis, the recommendation is to use saline nasal irrigation, topical intranasal corticosteroids, or both 1. For acute cases, the approach should focus on symptom management, with antibiotics considered only in severe or persistent cases. The specific choice of antibiotic, such as phenoxymethylpenicillin or doxycycline, should be guided by the most current clinical guidelines and patient factors, such as allergy history.

From the Research

Treatment for Sinusitis

The treatment for sinusitis is based on the UK Clinical Knowledge Summaries (CKS) guidance, which recommends the following:

• Antibiotics as the mainstay of medical treatment for sinusitis, with adjuvant treatments such as saline irrigation, decongestants, mucolytics, and anti-inflammatory agents playing a secondary role 2
• The use of systemic corticosteroids, which may be modestly beneficial for short-term relief of symptoms in acute sinusitis, with a number needed to treat to benefit of seven for resolution or symptom improvement 3
• A 10- to 14-day treatment course of antibiotics, although some studies suggest that short-course (< or =5 days) antibiotic therapy may have equivalent or superior efficacy compared with traditional longer therapies 4

Management of Acute Bacterial Rhinosinusitis (ABRS)

The management of ABRS includes:

• Distinguishing presumed ABRS from acute rhinosinusitis caused by viral upper respiratory infections and noninfectious conditions 5
• Diagnosing ABRS when symptoms or signs of acute rhinosinusitis are present 10 days or more beyond the onset of upper respiratory symptoms, or when symptoms or signs of acute rhinosinusitis worsen within 10 days after an initial improvement (double worsening) 5
• Assessing pain and providing analgesic treatment based on the severity of pain 5
• Prescribing amoxicillin as first-line therapy for most adults with ABRS 5

Use of Adjunctive Treatments

The use of adjunctive treatments, such as:

• Decongestants, which may not be effective in symptom relief 6
• Fluticasone propionate, which may be beneficial in patients with recurrent sinusitis 6
• Saline irrigation, mucolytics, and anti-inflammatory agents, which may play a secondary role in the treatment of sinusitis 2