Sinusitis and antibiotic treatment

The following antibiotics are recommended for the treatment of acute sinusitis:

• for adults aged 18 years and over
  • first choice
    • Phenoxymethylpenicillin - 500 mg four times a day for 5 days
  • first choice if systemically very unwell, symptoms and signs of a more serious illness or condition, or at high risk of complications
    • Co-amoxiclav - 500/125 mg three times a day for 5 days
  • alternative first choices for penicillin allergy or intolerance
    • Doxycycline - 200 mg on first day, then 100 mg once a day for 4 days (5-day course in total)
    • Clarithromycin - 500 mg twice a day for 5 days
    • Erythromycin (in pregnancy) - 250 mg to 500 mg four times a day or 500 mg to 1000 mg twice a day for 5 days
  • second choice (worsening symptoms on first choice taken for at least 2 to 3 days)
    • Co-amoxiclav - 500/125 mg three times a day for 5 days
      • if co-amoxiclav has been used as first choice, consult local microbiologist for advice on second choice
  • alternative second choice for penicillin allergy or intolerance, or worsening symptoms on second choice taken for at least 2 to 3 days
    • consult local microbiologist
• for children and young people under 18 years
  • first choice
    • Phenoxymethylpenicillin
      • 1 to 11 months, 62.5 mg four times a day for 5 days
      • 1 to 5 years, 125 mg four times a day for 5 days
      • 6 to 11 years, 250 mg four times a day for 5 days
      • 12 to 17 years, 500 mg four times a day for 5 days
  • first choice if systemically very unwell, symptoms and signs of a more serious illness or condition, or at high risk of complications
    • Co-amoxiclav
      • 1 to 11 months, 0.25 ml/kg of 125/31 suspension three times a day for 5 days
      • 1 to 5 years, 5 ml of 125/31 suspension three times a day or 0.25 ml/kg of 125/31 suspension three times a day for 5 days
      • 6 to 11 years, 5 ml of 250/62 suspension three times a day or 0.15 ml/kg of 250/62 suspension three times a day for 5 days
      • 12 to 17 years, 250/125 mg three times a day or 500/125 mg three times a day for 5 days
  • alternative first choice for penicillin allergy or intolerance
    • Clarithromycin
      • Under 8 kg, 7.5 mg/kg twice a day for 5 days
      • 8 to 11 kg, 62.5 mg twice a day for 5 days
      • 12 to 19 kg, 125 mg twice a day for 5 days
      • 20 to 29 kg, 187.5 mg twice a day for 5 days
      • 30 to 40 kg, 250 mg twice a day for 5 days
      • 12 to 17 years, 250 mg twice a day or 500 mg twice a day for 5 days
    • Doxycycline
      • is contraindicated in children under 12 years
      • 12 to 17 years, 200 mg on first day, then 100 mg once a day for 4 days (5-day course in total)
  • second choice (worsening symptoms on first choice taken for at least 2 to 3 days)
    • Co-amoxiclav - as above
      • If co-amoxiclav used as first choice, consult local microbiologist for advice on second choice
  • alternative second choice for penicillin allergy or intolerance, or worsening symptoms on second choice taken for at least 2 to 3 days
    • consult local microbiologist

Reference:

1. National Institute for Health and Care Excellence (NICE) 2017. Sinusitis (acute): antimicrobial prescribing
2. Public Health England (June 2021). Managing common infections: guidance for primary care