pharmacy first acute sinusitis

Question 1

what is acute sinusitis usually caused by

Answer 1

virus

very rarely bacteriaw

Question 2

how long should it tae for sinusutis to resolve

Answer 2

2-3 weeks without abx

Question 3

what are the red flags we should rule out frst

Answer 3

changes in vision
cellulitis around the eye
meningitis
swelling over frontal bone

Question 4

what are some signs of meningitis that should be ruled out

Answer 4

fever
severe headache
neck stiffness
nausea
vomiting
photophobia
- required immediate medical attention - refer to A&E if suspected

Question 5

what is the diagnostic criterua for actue sinusitis as per pharmacy first inclusion

Answer 5

Diagnose acute sinusitis by the presence of ONE or more of:
☐ Nasal blockage (obstruction/congestion) or
☐ Nasal discharge (anterior/posterior nasal drip)
With ONE or more of:
☐ Facial pain/pressure (or headache) or
☐ Reduction (or loss) of the sense of smell (in adults)
☐ Cough during the day or at night (in children)

Question 6

if the patinent has had symptoms for less than ten days what do we do

Answer 6

offer self care advice
inform them that it should resolve itself in 2-3 weeks
severe deterioration and changes to vision = immediate refferal
if there are symptoms that persist longer than 2-3 weeks - come back into the pharmacyt

Question 7

what is the secondary inclsuion criteria

Answer 7

Does the patient have 2 or more of the following
symptoms to suggest acute bacterial sinusitis:
☐ Marked deterioration after an initial milder phase
☐ Fever (>38°C)
☐ Unremitting purulent nasal discharge
☐ Severe localised unilateral pain, particularly pain
over the teeth (toothache) and jaw

Question 8

what nasal corticosteroids can be offered

Answer 8

fluticasone
mometasone

Question 9

how long should the high dose nasal steroid be offered for

Answer 9

14 days

Question 10

what antibiotics should be offered if the nasal spray is contraindicated or not tolerated

Answer 10

phenoxymethylpenicillin
clarithromycin (if penicillin allergic)
erythromycin (if pregnant)

Question 11

what resources should be shared with the patient

Answer 11

TARGET leaflet for respiratory tract infections
PIL for chosen drug treatment if relevant
self care advice
safety netting

Question 12

what self care advice can we offer someone with acute sinusitis

Answer 12

fluids to dulite mucous secretions
warm compress to face - warm flannel
breathing in vapour over a bowl of water
nasal rinses with salt water
OTC medications !!

Question 13

who is included in this pharmacy first

Answer 13

immunosurpressed individuals
>12
non pregnant under 16
people who have not had sinusitis previously where it has lasted more than 12 weeks