How can I effectively manage a patient with recurrent acute sinusitis in primary care?

Effective management of a patient with recurrent acute sinusitis in primary care involves:

• Assessment and diagnosis: Reassess the patient to exclude alternative diagnoses such as dental infection or more serious conditions, especially if symptoms worsen rapidly or significantly ¹.
• Symptomatic treatment: Advise use of paracetamol or ibuprofen for pain or fever relief ¹. Nasal saline irrigation or nasal decongestants may be tried for congestion, although evidence for their effectiveness is limited ¹.
• Intranasal corticosteroids: For adults and children aged 12 years and over, consider a 14-day course of high-dose nasal corticosteroids (e.g., mometasone 200 mcg twice daily) to improve symptoms, particularly if allergic rhinitis is suspected ¹.
• Antibiotic prescribing: Avoid routine antibiotics as bacterial sinusitis is usually self-limiting and antibiotics have limited benefit on symptom duration or improvement ¹. Consider a back-up antibiotic prescription if bacterial infection is more likely (symptoms >10 days, purulent nasal discharge, severe localized pain, fever >38°C, or double worsening) ¹.
• Self-management advice: Provide written and verbal advice on the usual viral cause and natural course of sinusitis, self-care strategies, and when to seek further medical help ¹,⁵.
• Address contributing factors: Advise avoidance of allergic triggers, smoking cessation, good dental hygiene, and control of comorbidities such as asthma or allergic rhinitis to reduce recurrence ¹.
• Referral criteria: Refer to ENT or immunology specialists if symptoms persist beyond 6–12 weeks, significantly affect quality of life, or if there is suspicion of anatomical defects, immunodeficiency, nasal polyps, or resistant bacteria ¹.