● Urgent care clinic · 30-minute consult
Sinusitis
Viral until day 10 — and don’t miss the orbit.
Typical consult⏱ 10 min
Investigations🔬 None
Usual outcome💊 Self-care ± nasal steroid / back-up antibiotic
0–5Red flags + history5–12Examine12–17Decide17–24Treat + explain24–30Safety-net + document
1Rule out first — red flags
| If you find… | …then |
|---|---|
| Periorbital swelling, double vision, painful or reduced eye movements, reduced acuity | Orbital complication — ENT/ophthalmology now |
| Severe frontal headache, frontal swelling, neuro signs, meningism | Intracranial complication — ED |
| Systemically very unwell | Admit |
2Focused history
3Focused examination
4Decide — investigate only if it changes the plan
NICE NG79
- Symptoms ≤ 10 days → no antibiotic (self-care)
- Symptoms ≥ 10 days without improvement → no antibiotic or back-up; consider high-dose nasal steroid for 14 days (age 12+)
- Systemically very unwell / high risk → immediate antibiotic
Antibiotics make little difference to how long symptoms last.
| Investigation | Only if… |
|---|---|
| None | Imaging is not needed for uncomplicated sinusitis |
5Treat & send home
Management & advice
- Paracetamol or ibuprofen; saline nasal irrigation may help
- Most settle within 2–3 weeks
Refer / follow-up
- Orbital / intracranial signs → ENT / ED
- Recurrent or chronic (> 12 weeks) → GP
℞
Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.
| Drug | Dose | Duration / notes |
|---|---|---|
| Paracetamol | 1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk) | As needed |
| Ibuprofen | 400 mg three times a day with food | 3–5 days. Avoid: NSAID-sensitive asthma, GI bleed/ulcer, renal impairment, anticoagulants, heart failure, pregnancy |
| Mometasone nasal spray (≥ 10 days, age 12+) | 200 micrograms (2 sprays each nostril) twice a day | 14 days (off-label high dose) |
| Phenoxymethylpenicillin (if indicated) | 500 mg four times a day | 5 days |
| Systemically very unwell / high risk: co-amoxiclav | 500/125 mg three times a day | 5 days |
| Penicillin allergy: doxycycline | 200 mg on day 1, then 100 mg once a day | 5 days total (or clarithromycin 500 mg twice a day for 5 days) |
6Safety-net
Say it like this
This is sinusitis, almost always from a cold virus. Antibiotics don’t make it go away faster. Painkillers and saline rinses help, and it usually clears within 2 to 3 weeks. Come back straight away if you get swelling around your eye, double vision or changes in your eyesight, or a severe headache.
Come back / call 111 — or 999 if severe — if:
- Swelling or redness around the eye, double vision, or changes in eyesight
- Severe headache, confusion, stiff neck
- Very high fever or feeling very unwell
7Patient leaflets — scan & go
Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.
8Document
Sinusitis — clinic note
A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.
URGENT CARE — SINUSITIS
PRESENTING COMPLAINT:
HISTORY
Duration (< 10 days = viral):
Facial pain/pressure, nasal blockage, discoloured discharge, reduced smell:
“Double sickening” (better then worse):
Eye symptoms, headache, fever:
RED FLAGS (record present / absent)
[ ] Periorbital swelling, double vision, painful or reduced eye movements, reduced acuity
[ ] Severe frontal headache, frontal swelling, neuro signs, meningism
[ ] Systemically very unwell
PMH:
DRUG HISTORY:
ALLERGIES:
SOCIAL (job / who is at home / driving):
OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 )
EXAMINATION
Obs:
Facial tenderness:
Eyes: swelling, movements, acuity:
Neuro if headache:
DECISION RULE — NICE NG79: result ______
INVESTIGATIONS: none required / None — result:
IMPRESSION:
PLAN
Treatment / TTO (drug, dose, duration):
Advice given:
Leaflet given (QR / printed): Sinusitis (sinus infection), Antibiotics — when you need them
Follow-up / referral:
SAFETY-NETTING (told to return / call 111 / 999 if):
- Swelling or redness around the eye, double vision, or changes in eyesight
- Severe headache, confusion, stiff neck
- Very high fever or feeling very unwell
Patient understands and agrees with the plan: Y / N
Seen by: Grade: Date/Time:
✓Guidelines
Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.
More ear, nose, throat & eyes
Sore throat & tonsillitisFeverPAIN decides — and don’t miss the quinsy or epiglottitis.Earache: otitis media & externaMostly no antibiotics — but spot mastoiditis and malignant otitis externa.Nosebleed (epistaxis)Proper first aid, cautery if you can see it, and who needs ENT.Red eye & conjunctivitisConjunctivitis is a diagnosis of exclusion — check acuity and pain first.