Sinusitis, Acute, Bacterial

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Click here to access the Primary-Healthcare-Chapter-19-Ear-Nose-and-Throat-with-supporting-NEMLC-report-2020-4-review-2-December-2025

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Description

General Measures 

Medicine Treatment 

Referrals 

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ICD-10 Code: J01.0-4/J01.8-9

DESCRIPTION

• Bacterial infection of one or more paranasal sinuses that occurs most often after a viral nasal infection or allergic rhinitis
• Bacterial sinusitis is characterised by:
  • Deterioration of a common cold after 5–7 days
  • Headache
  • Purulent nasal discharge, especially if unilateral
  • Pain and tenderness over one or more sinuses
  • Nasal obstruction
  • Fever

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Note:
Sinusitis is uncommon in children <5 years of age, as sinuses are not fully developed

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GENERAL MEASURES

• Consider HIV in recurrent sinusitis

MEDICINE TREATMENT

Children ≤3 years of age

• Amoxicillin, oral, 45 mg/kg/dose 12 hourly for 5 days

Weight  kg	Dose  mg	Use one of the following				Age Months/ years
		Syrup  mg/ 5 mL		Capsule  mg
		125	250	250	500
>2–2.5 kg	100	4 mL	2 mL	–	–	34–36 weeks
>2.5–3.5 kg	125	5 mL	2.5 mL	–	–	Birth–1 month
>3.5–5 kg	175	7 mL	3.5 mL	–	–	>1–3 months
>5–7 kg	250	10 mL	5 mL	–	–	>3–6 months
>7–11 kg	375	15 mL	7.5 mL	–	–	>6–18 months
>11–14 kg	500	–	10 mL	2	1	>18 months–3 years

Children >3 years of age

• Amoxicillin, oral, 500 mg, 8 hourly for 5 days

Adults

• Amoxicillin, oral, 500 mg 8 hourly for 5 days                                                          

Severe penicillin allergy: 
ICD-10 Code: Z88.0

Children

• Macrolide, e.g.:
  • Azithromycin, oral, 10 mg/kg daily for 3 days. See: dosing table

Children >35 kg and adults

• Macrolide, e.g.:
  • Azithromycin, oral, 500 mg daily for 3 days

AND

• Oxymetazoline, nose drops, 2 drops in each nostril 6–8 hourly for not more than 5 days continuously
  • Children >5 years of age : 0.025%
  • Adults: 0.05%

LoE:III³⁹⁴

AND/OR

• Sodium chloride 0.9%, nose drops, use frequently and in fairly large volumes

Pain:

Children

• Paracetamol, oral, 10-15 mg/kg/dose 6 hourly when required. See: dosing table

Adults

• Paracetamol, oral, 1 g, 4-6 hourly when required 
  • Maximum dose: 15 mg/kg/dose
  • Maximum dose: 4 g in 24 hours

REFERRAL

• Fever lasting >48 hours
• Poor response >5 days
• Complications, e.g. periorbital cellulitis with periorbital swelling
• Oedema over a sinus
• Recurrent sinusitis
• Meningeal irritation

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2024 Edition