Pharmacy First Pathway Editor

Acute Sinusitis (Pharmacy First)

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no>=10YESNo allergyAllergyNot pregnant>=1>=2 signs>=1>=100yesno<2 signs0Pregnant
Question

Diagnose acute sinusitis by the presence of ONE or more of the below, Select ANY that apply:

diagnostic_symptoms decision select_multiple
Outcome

Offer phenoxymethylpenicillin (if no allergy) for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care.

outcome_penicillin_v outcome info
Question

Is the patient pregnant?

pregnancy_check decision select
Question

Has the patient had symptoms for ≤10 days?

duration_check decision select
Outcome

Self-care and pain relief. • Antibiotic is not needed • Sinusitis usually lasts 2–3 weeks • Manage symptoms with self-care • Safety netting advice

outcome_early_self_care outcome info
Outcome

Self-care and pain relief. Shared decision making approach based on severity of symptoms. Offer high dose nasal corticosteroid (off-label) for 14 days (subject to inclusion/exclusion criteria in PGD). • 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 Ask patient to return to Community Pharmacy if symptoms do not improve in 7 days for pharmacist reassessment.

outcome_steroid_low outcome info
Outcome

Shared decision making approach based on severity of symptoms. Offer high dose nasal corticosteroid (off-label) for 14 days (subject to inclusion/exclusion criteria in PGD) plus self care and pain relief instead of antibiotics first line. Or if unsuitable or ineffective offer antibiotics.

outcome_steroid_high outcome info
Question

Is nasal corticosteroid unsuitable or ineffective?

steroid_suitability decision select
Outcome

Offer clarithromycin OR doxycycline for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care.

outcome_clarithromycin outcome info
Outcome

Offer erythromycin for 5 days (subject to inclusion/exclusion criteria in PGD) plus self care.

outcome_erythromycin outcome info
Question

Reported penicillin allergy (via National Care Record or Patient/Carer)?

allergy_check decision select
Question

Is the patient eligible for the Acute Sinusitis pathway? Select ANY that apply

eligibility checklist select_multiple
Referral

Patient is not eligible for this pathway. Refer to GP or appropriate service.

outcome_not_eligible referral info
Referral

Urgent: call 999 or signpost patient to A&E immediately. Consider calculating NEWS2 Score ahead of signposting patient to A&E or calling 999 in a life-threatening emergency.

outcome_emergency referral info
Question

Select ANY of the below that apply:

diagnostic_symptoms_copy select_multiple
Info

Patient presenting signs and symptoms of acute sinusitis?

intro_guidance info_panel info
Outcome

Acute sinusitis less likely. Consider alternative diagnosis and proceed appropriately.

outcome_not_sinusitis_copy info
Outcome

Acute sinusitis less likely. Consider alternative diagnosis and proceed appropriately.

outcome_not_sinusitis outcome info
Question

Consider the risk of deterioration or serious illness. Select ANY that apply.

emergency_screen decision select_multiple
Question

Does the patient have 2 or more of the following symptoms to suggest acute bacterial sinusitis, Select ANY that apply:

bacterial_signs decision select_multiple

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