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Acute Sinusitis (Pharmacy First)

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sepsis<2 signs[cancer]>=100>=10>=10yesno>=2 signsYESNo allergyAllergyNot pregnantPregnant>=10noalways>=1
Info

Patient presenting signs and symptoms of acute sinusitis?

intro_guidance info_panel info
Referral

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

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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.

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Outcome

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

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Question

Has the patient had symptoms for ≤10 days?

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Outcome

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

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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.

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Question

Is nasal corticosteroid unsuitable or ineffective?

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Question

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

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Question

Select ALL that apply. If none apply, select "none apply".

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Question

Select ALL that apply. If none apply, select "none apply".

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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 6a and 6b). • 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.

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Outcome

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

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Question

Is the patient pregnant?

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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
Outcome

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

outcome_not_sinusitis_copy info
Question

Select ALL that apply. If none apply, select "none apply".

diagnostic_symptoms_copy select_multiple
Question

Select ALL that apply. If none apply, select "none apply".

emergency_screen decision select_multiple
Question

Select ALL that apply. If none apply, select "none apply".

urgent_screen_steroid decision select_multiple
Question

Select ALL that apply. If none apply, select "none apply".

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Referral

Urgent: Sepsis suspected. Call 999 IMMEDIATELY. Consider calculating NEWS2 Score ahead of signposting patient to A&E or calling 999 in a life-threatening emergency.

outcome_sepsis referral info
Referral

Urgent: special PGD exclusion criteria met. Refer urgently to a prescriber for further assessment.

outcome_urgent_steroid referral info
Referral

Urgent: suspected possible cancer. Refer urgently to a prescriber for further assessment. Do not offer high-dose nasal corticosteroid (PGD 6a, 6b).

outcome_cancer_steroid referral info
Question

Select ALL that apply. If none apply, select "none apply".

exclusion_steroid decision select_multiple

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