ENT

Acute Sinusitis

سائنس کی سوزش

Sudden headache, usually one-sided and worse on leaning forward, with nasal discharge and sinus tenderness.

ICD-10: —
Source: OPD handbook pp.25–27
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Headache, sudden onset, usually unilateral, worse by leaning forward
Nasal discharge

Diagnosis

Differential diagnosis: migraine (mostly females, preceding aura, unilateral, previous episodes, pain lasting 3 hours to 3 days)
Differential diagnosis: tension-type headache (continuous band-like pain, worse in the evening)
Differential diagnosis: cluster headache (mostly males, red eye, congested nose, lacrimation)
Take vitals; examine the nose (for deviated nasal septum); sinus tenderness positive means acute sinusitis

Treatment

Step 1 of 5

1. Antibiotics

Levofloxacin is the drug of choice

Prescription

LevofloxacinFluoroquinolone antibiotic

Dose250 mg BD (1+1)

Brand L-Cyn / Efflox / Leflox

Also sold as L-Cyn, Leflox, Efflox (spelling unclear in book), Levo

Amoxicillin + Clavulanic acidPenicillin antibiotic + β-lactamase inhibitor

Dose625 mg TDS

Brand Augmentin

Also sold as Augmentin, Co-Amoxiclave, Calamox

Caution: Penicillin allergy; Cholestatic jaundice risk with prolonged use

MoxifloxacinFluoroquinolone antibiotic

Dose400 mg OD

Brand Mofest / Moxef

Also sold as Mofest, Moxef, Avelox, Moxiget

Step 2 of 5

2. NSAIDs

Prescription

Paracetamol (Acetaminophen)Analgesic / antipyretic

Dose500 mg TDS, 2+2+2

Brand Panadol

Also sold as Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL)

Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease

NimesulideNSAID

Dose100 mg BD

Brand Nims

Also sold as Nims, Nimusil

NaproxenNSAID

Dose500 mg BD

Brand Neoprox

Also sold as Neoprox, Neopron, Flexin, Synflex

IbuprofenNSAID

Dose400 mg TDS

Brand Brufen

Caution: Avoid in dengue (bleeding risk); Avoid in kidney disease, peptic ulcer, late pregnancy; Take with food

DexibuprofenNSAID

Dose400 mg TDS

Brand Tercica

Ibuprofen + PseudoephedrineNSAID + decongestant

Dose1+1+1

Brand Arinac Forte 200/60 mg

Also sold as Arinac Forte, Arinac syrup

Step 3 of 5

3. Antihistamine

Prescription

FexofenadineAntihistamine

Dose60 mg BD

Brand Fexet

Also sold as Fexet, Telfast

LoratadineAntihistamine

Dose10 mg OD

Brand Jardin

Also sold as Jardin, Softin

DesloratadineAntihistamine

Dose10 mg OD

Brand Desora

Step 4 of 5

4. Decongestant

Prescription

Fexofenadine + PseudoephedrineAntihistamine + decongestant

Dose1+1

Brand Fexet D 60/120 mg

Step 5 of 5

5. Nebulization

Nebulize with normal saline (0.9%)
Steam inhalation; avoid dust and smoke

Prescription

Normal saline nebulization (0.9%)Nebulization / mucolytic support

DoseNebulize with N/S

Brands Generic / hospital supply

Sample prescription from the book (patient details removed)

Adult female, 22 y, headache since morning worsened on going down (leaning), previous history of nasal discharge; congested inflamed nasal mucosa: Tab L-Cyn 250 mg 1+1; Tab Panadol 500 mg 2+2+2 if pain; Tab Fexet D 60/120 mg 1+1; nebulize with N/S; steam; avoid dust and smoke.