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Overview
Consider calculating NEWS2 Score ahead of signposting patient to A&E or calling 999 in a life threatening emergency
Consider calculating NEWS2 Score ahea...
Patient presenting with
signs and symptoms of acute sinusitis
Patient presenting with...
NHSE PATHWAYS
NHSE PATHWAYS
Consider the risk of deterioration, red flags or serious illness
Consider the risk of deterioration, red flags or serious illness
Diagnose acute sinusitis by the presence of ONE or more of:
  • Nasal blockage (obstruction/congestion) or
  • Nasal discharge (anterior/posterior nasal drip)
With ONE or more of:
  • Facial pain/pressure (or headache) or
  • Reduction (or loss) of the sense of smell (in adults)
  • Cough during the day or at night (in children)
Diagnose acute sinusitis by the presence of ONE or more of:...
YES
YES
NO
NO
NICE CKS
NICE CKS
NHSE PGDs
NHSE PGDs View PGD in right panelView PGD in right panel
Digital PGD
 Digital PGD
Gateway Point
Gateway Point
Consider alternative diagnosis and proceed appropriately
Consider alternative diagnosis and...
NO
NO
YES
YES
If pregnant
 If pregnant

Content sourced and adapted from NHS Pharmacy First – Clinical Pathways and Patient Group Directions (PGDs) on the NHS England website, licensed under the Open Government Licence v3.0.

Content sourced and adapted from NHS Pharmacy First – Clinical Pathways and Patient Group Directions (PGDs) on the NHS England website, licensed under the Open Government Licence v3.0.
Acute Sinusitis (For adults and children aged 12 years and over)
Acute Sinusitis Context: UK Pharmacy First Scheme Acute Sinusit...
Acute sinusitis is usually caused by a virus and is only complicated by bacterial infection in about 2 in 100 cases. 
It takes 2–3 weeks to resolve, and most people will get better without antibiotics. Please share NICE information for the public.
Acute sinusitis is usually caused by a virus and is only complicated by bacterial infection in about 2 in 100 cases....
  • Intraorbital or periorbital complications such as orbital cellulitis, displaced eyeball, reduced vision
  • Intracranial complications, including swelling over the frontal bone
  • Signs of meningitis, severe frontal headache, or focal neurological signs
...
Gateway Point
Gateway Point
Does the patient have 2 or more of the following symptoms to suggest acute bacterial sinusitis:
  • Marked deterioration after an initial milder phase
  • Fever (>38°C)
  • Unremitting purulent nasal discharge
  • Severe localised unilateral pain, particularly pain over the teeth (toothache) and jaw
Does the patient have 2 or more of the following symptoms to suggest acute bacterial...
YES
YES
NO
NO
Onward referral
  • General practice
  • Other provider as appropriate
Onward referral...
or if unsuitable or ineffective
or if unsuitable or ineffective
Exclude: immunosuppressed individuals, chronic sinusitis (sinusitis that causes symptoms that last for more than 12 weeks), pregnant individuals under 16 years
Exclude: immunosuppressed individuals, chronic sinusitis (sinusitis that causes symptoms that last for more than 12 weeks), pregnant individual...
Acute sinusitis less likely
Acute sinusitis less likely
Has the patient had symptoms for
>10 days with no improvement?
Has the patient had symptoms for...
Has the patient had symptoms for ≤10 days?
Has the patient had symptoms for ≤10 days?
YES
YES
YES
YES
Acute sinusitis is a potential differential diagnosis
Acute sinusitis is a potential differential di...
Self-care and regular pain relief
Self-care and regular pain relief
  • Antibiotic is not needed
  • Sinusitis usually lasts 2-3 weeks
  • Manage symptoms with self-care
  • Safety netting advice
...
FOR ALL PATIENTS: share self-care and safety-netting advice using TARGET Respiratory Tract Infection leaflet
FOR ALL PATIENTS: share self-care and safety-netting advice using TARGET Respiratory Tract Infection leaflet
Sinusitis
Sinusitis
NHS
NHS
If symptoms worsen rapidly or significantly at any time,
OR do not improve after completion of 5 days treatment course
If symptoms worsen rapidly or significantly at any time,...
Offer erythromycin for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care
Offer erythromycin for 5 days (subjec...
Offer clarithromycin OR doxycycline
for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care
Offer clarithromycin OR doxycycline...
Reported penicillin allergy
(via National Care Record or Patient/Carer)
Reported penicillin allergy...
Offer phenoxymethylpenicillin (if no allergy) for 5 days
(subject to inclusion/exclusion criteria in PGD)
plus self care
Offer phenoxymethylpenicillin (if no allergy) fo...
Self care and regular pain relief
Self care and regular pain relief
  • Acute sinusitis is usually caused by a virus
  • Antibiotics make little difference to how long symptoms last or the number of people whose symptoms improve
...
Shared decision making 
approach based on severity of symptoms
Shared decision making...
Ask patient to return to Community Pharmacy if symptoms do not improve in 7 days for pharmacist reassessment
Ask patient to return to Community Pharmacy if s...
Shared decision making 
approach based on severity of symptoms
Shared decision making...
Offer high dose nasal corticosteroid
(offlabel) for 14 days
(subject to inclusion/exclusion criteria in PGD)
Offer high dose nasal corticosteroid...
Offer high dose nasal corticosteroid
(offlabel) for 14 days
(subject to inclusion/exclusion criteria in PGD)
plus self care and pain relief instead of antibiotics first line
Offer high dose nasal corticosteroid...Text is not SVG - cannot display