Dawaa Reference

infectious

Acute bacterial rhinosinusitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

Egyptian National Drug Formulary - Antimicrobial 2023 (cefuroxime monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (moxifloxacin monograph) · Egyptian National Drug Formulary - Respiratory Medicines 2026, Fluticasone monograph, intra-nasal adults and adolescents 12 years and over · IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis 2012 · NICE NG79 Sinusitis (acute): antimicrobial prescribing, 27 October 2017, recommendation 1.1.4

Verified against6 documents
  • Egyptian National Drug Formulary - Antimicrobial 2023 (cefuroxime monograph)
  • Egyptian National Drug Formulary - Antimicrobial 2023 (moxifloxacin monograph)
  • Egyptian National Drug Formulary - Respiratory Medicines 2026, Fluticasone monograph, intra-nasal adults and adolescents 12 years and over
  • IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis 2012
  • NICE NG79 Sinusitis (acute): antimicrobial prescribing, 27 October 2017, recommendation 1.1.4
  • Acute bacterial rhinosinusitis - disease-level clinical article (acute-sinusitis-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • Thick discolored nasal discharge together with either a blocked nose or facial pressure [blocked nose · runny nose]
  • Facial pressure is more typical of sinusitis than an isolated headache is [headache]
  • Symptoms lasting beyond 10 days, or improving then worsening again, point to a bacterial cause
  • Cough, tiredness, reduced or lost sense of smell, and dental or ear pressure can accompany sinusitis [cough · fatigue · loss of smell]
  • Children with bacterial sinusitis run fevers more often, and discharge that starts watery turns thick
  • A high fever with purulent discharge or facial pain persisting three to four days at the start suggests a bacterial cause [facial pain · fever · pus]

Signs — what you find (6)

  • Pus visible in the nasal passage or back of the throat is the only exam finding with real diagnostic weight [pus]
  • Nasal-sounding speech points to a blocked nose [blocked nose]
  • Redness or swelling localized over the cheekbone or around the eye can occur [redness]
  • Tenderness on pressing the cheek or tapping the upper teeth can be elicited
  • Look for spread beyond the sinus: eye or facial cellulitis, a bulging eye, abnormal eye movement, or a stiff neck [cellulitis · neck stiffness]
  • Endoscopy can show pus draining from the middle meatus along with polyps or structural problems [polyp · pus]

Tests (8)

  • Blood markers like ESR and CRP may be raised but do not point to a specific cause
  • A complete blood count is often unremarkable
  • Nasal cell samples can help tell allergic rhinitis, eosinophilic disease, or nasal polyps apart
  • Sinus cultures add little value unless the patient is immunocompromised, not responding to treatment, or has a complication
  • Plain sinus x-rays can show clouding, thickened lining, or fluid levels but are usually not reliable enough to use
  • CT is the reference test for chronic sinusitis but a poor discriminator for the acute form, since fluid levels turn up incidentally in many healthy or virus-infected people
  • MRI is reserved for suspicion of a tumor or fungal spread beyond the sinus
  • The diagnosis needs at least two major symptoms, or one major plus two minor ones

If not this — what else fits (8)

  • The common cold from rhinovirus can look the same early on
  • Allergic or nonallergic rhinitis and asthma sit on the differential list
  • A dental abscess can refer pain to the sinus region
  • Migraine and tension headache belong on the differential for facial or head pain
  • A tumor of the nose or sinus can present similarly to chronic sinus disease
  • A foreign object lodged in the nose or a deviated septum can produce similar obstruction
  • Enlarged tonsils and adenoids, or enlarged turbinates, can also block the nose
  • Immune deficiency should be considered when sinus infections keep recurring

SourceStatPearls "Acute Sinusitis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Second-line antibiotic | If penicillin-allergic | Symptom relief after 10 days

MAIN TREATMENT - choose one

1

AMOXICILLIN + CLAVULANIC ACID

1st line

Strength625 mg

Formoral.solid

Adult dose and duration

1 g (875/125 mg) BID or 625 mg (500/125 mg) TID x 5-7 days

Paediatric dose

45-90 mg/kg/day [child max 4000 mg]

(Based on amoxicillin component in 2 divided doses daily)

Dose by weight
3kg135-270 mg/day
4kg180-360 mg/day
5kg225-450 mg/day
6kg270-540 mg/day
7kg315-630 mg/day
8kg360-720 mg/day
9kg405-810 mg/day
10kg450-900 mg/day
11kg495-990 mg/day
12kg540-1080 mg/day
13kg585-1170 mg/day
14kg630-1260 mg/day
15kg675-1350 mg/day
16kg720-1440 mg/day
17kg765-1530 mg/day
18kg810-1620 mg/day
19kg855-1710 mg/day
20kg900-1800 mg/day
21kg945-1890 mg/day
22kg990-1980 mg/day
23kg1035-2070 mg/day
24kg1080-2160 mg/day
25kg1125-2250 mg/day
26kg1170-2340 mg/day
27kg1215-2430 mg/day
28kg1260-2520 mg/day
29kg1305-2610 mg/day
30kg1350-2700 mg/day
31kg1395-2790 mg/day
32kg1440-2880 mg/day
33kg1485-2970 mg/day
34kg1530-3060 mg/day
35kg1575-3150 mg/day
36kg1620-3240 mg/day
37kg1665-3330 mg/day
38kg1710-3420 mg/day
39kg1755-3510 mg/day
40kg1800-3600 mg/day
41kg1845-3690 mg/day
42kg1890-3780 mg/day
43kg1935-3870 mg/day
44kg1980-3960 mg/day
45kg2025-4000 mg/day (upper capped)
46kg2070-4000 mg/day (upper capped)
47kg2115-4000 mg/day (upper capped)
48kg2160-4000 mg/day (upper capped)
49kg2205-4000 mg/day (upper capped)
50kg2250-4000 mg/day (upper capped)
Dose source

IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis 2012

Why

First-line empiric coverage for S. pneumoniae, H. influenzae, M. catarrhalis

Cautions
  • Caution in hepatic impairment or history of amoxicillin-clavulanate jaundice.
  • Take with food to minimize gastrointestinal adverse effects.
  • Discontinue if allergic skin rash develops.
Egyptian brands
Egyptian brandManufacturerIndicative price
AUJED 625 MG 12 F.C. TAB.SIGMA TEC > JEDCO INT. CO. FOR PHARMACEUTICALS19.20 EGP (1.60/unit)
E-MOXCLAV 625MG 10 TAB.EIPICO30.00 EGP (3.00/unit)
DEXICLAVE 625 MG 12 F.C. TABS.RAMEDA > NOVELL PHARMA37.50 EGP (3.12/unit)
MAGNABIOTIC 625MG 8 TAB.SEDICO37.00 EGP (4.62/unit)
CLAVIMOX 625 MG 12 F.C.TABS.PHARCO107.00 EGP (8.92/unit)
CURAM 625MG 12 F.C.TAB.SANDOZ > NOVARTIS108.00 EGP (9.00/unit)
AUGMENTIN 625 MG 10 F.C.TABS.MUP > SMITHKLINE BEECHAM117.00 EGP (11.70/unit)
CLAVOCILLIN 625 MG 10 DISPERSIBLE TABS.RAMEDA > ORGANOPHARMA31.50 EGP
LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML? strength differs? different route - not oral solidMISR > AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.8.00 EGP
MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML? strength differs? different route - not oral solidCID8.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Acute bacterial rhinosinusitis - disease-level clinical article (acute-sinusitis-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Watch for spread of sinus infection to the orbit, bone, or intracranial cavities.
3

MOXIFLOXACIN

alternative

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg once daily by mouth - Not fixed in the source - the formulary advises individualising duration by clinical response, extent of disease and toxicity

Paediatric dose

The formulary states fluoroquinolones are not routinely first-line in children and gives no paediatric sinusitis dose. Do not use in a child for sinusitis.

AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (moxifloxacin monograph)

Why

53 live products, and the formulary lists acute bacterial rhinosinusitis explicitly. Placed at line 4 to match the formulary's own limitation of use rather than at the line its market share would suggest.

Cautions
  • The formulary's own limitation of use: reserve moxifloxacin for acute sinusitis only in patients who have no alternative treatment option.
  • Disabling and potentially irreversible reactions: tendinopathy and tendon rupture, peripheral neuropathy, and CNS effects - stop at the first tendon pain or new paraesthesia.
  • There is an aortic aneurysm and dissection risk - avoid in a patient with known aortic disease, Marfan syndrome, or uncontrolled hypertension.
  • QT prolongation - avoid with other QT-prolonging drugs and in uncorrected hypokalaemia.
  • Absorption is destroyed by antacids, iron, calcium, zinc and sucralfate - separate by at least 4 hours.
  • No dose adjustment is needed in renal or hepatic impairment, but use with caution in liver disease because of the QT risk.
Egyptian brands
Egyptian brandManufacturerIndicative price
MOXILABACT 400 MG 5 F.C. TABS.KAHIRA30.60 EGP (6.12/unit)
GASTAMOXACINE 400MG 7 F.C. TAB.MEDIZEN PHARMACEUTICAL INDUSTRIES > GAST PHARMA GROUP-EGYPT45.00 EGP (6.43/unit)
MERAMERIX 400MG 5 F.C.TAB.PHARMED HEALTHCARE > ABBOTT LABORATORIES40.50 EGP (8.10/unit)
IDELOX 400MG 10 F.C. TAB.RAMEDA116.00 EGP (11.60/unit)
PRIMOXIZAR 400 MG 5 F.C. TAB.PHARMA CURE PHARMACEUTICALS > PHARMA CURE80.00 EGP (16.00/unit)
MOXIFLOX 400 MG 10 F.C.TABS.EVA PHARMA180.00 EGP (18.00/unit)
MOXAVIDEX 400 MG 10 F.C.TABS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > UTOPIA184.00 EGP (18.40/unit)
MOXAVIDEX 400 MG 5 F.C.TABS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > UTOPIA92.00 EGP (18.40/unit)
MOXIFLOXACIN-EL NILE 400MG/250ML SOL. FOR INF.? strength differs? different route - not oral solidEL NILE.80.50 EGP
MOXITRIX 400MG/250ML SOL. FOR INF.? strength differs? different route - not oral solidARAB CO. FOR MEDICAL PRODUCTS > SPIMACO MISR86.00 EGP

SECOND-LINE ANTIBIOTIC

4

CEFUROXIME

Second-line antibiotic

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

250 mg or 500 mg twice daily with food x 10 days

Paediatric dose

20-30 mg/kg/day [child max 1000 mg]

(Mild to moderate infection: 20-30 mg/kg/day orally divided twice daily, maximum 500 mg per dose (so 1000 mg/day). Oral suspension 125 mg/5 mL and 250 mg/5 mL, licensed from 3 months.)

Dose by age
3 months and over:Mild to moderate infection: 20 to 30 mg/kg/day by mouth divided twice daily, maximum 500 mg per dose. Suspension licensed from 3 months.
Dose by weight
3kg60-90 mg/day
4kg80-120 mg/day
5kg100-150 mg/day
6kg120-180 mg/day
7kg140-210 mg/day
8kg160-240 mg/day
9kg180-270 mg/day
10kg200-300 mg/day
11kg220-330 mg/day
12kg240-360 mg/day
13kg260-390 mg/day
14kg280-420 mg/day
15kg300-450 mg/day
16kg320-480 mg/day
17kg340-510 mg/day
18kg360-540 mg/day
19kg380-570 mg/day
20kg400-600 mg/day
21kg420-630 mg/day
22kg440-660 mg/day
23kg460-690 mg/day
24kg480-720 mg/day
25kg500-750 mg/day
26kg520-780 mg/day
27kg540-810 mg/day
28kg560-840 mg/day
29kg580-870 mg/day
30kg600-900 mg/day
31kg620-930 mg/day
32kg640-960 mg/day
33kg660-990 mg/day
34kg680-1000 mg/day (upper capped)
35kg700-1000 mg/day (upper capped)
36kg720-1000 mg/day (upper capped)
37kg740-1000 mg/day (upper capped)
38kg760-1000 mg/day (upper capped)
39kg780-1000 mg/day (upper capped)
40kg800-1000 mg/day (upper capped)
41kg820-1000 mg/day (upper capped)
42kg840-1000 mg/day (upper capped)
43kg860-1000 mg/day (upper capped)
44kg880-1000 mg/day (upper capped)
45kg900-1000 mg/day (upper capped)
46kg920-1000 mg/day (upper capped)
47kg940-1000 mg/day (upper capped)
48kg960-1000 mg/day (upper capped)
49kg980-1000 mg/day (upper capped)
50kg1000 mg/day (capped)
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (cefuroxime monograph)

Why

18 live products. The formulary carries an explicit oral indication - 'Sinusitis, acute bacterial (tablets and oral suspension only): treatment of mild to moderate acute bacterial maxillary sinusitis' - which makes it the correct beta-lactam alternative when amoxicillin-clavulanate has failed or is not tolerated.

Cautions
  • Take with food - absorption of the tablet falls substantially on an empty stomach.
  • Avoid in immediate-type (anaphylactic) penicillin allergy; cross-reactivity with other beta-lactams.
  • The formulary places cefuroxime in the WATCH group - do not use it ahead of amoxicillin-clavulanate.
  • Most acute rhinosinusitis is viral; reserve any antibiotic for symptoms beyond 10 days, double worsening, or severe systemic features.
  • Reduce the frequency to every 12 or 24 hours if creatinine clearance is below 20 mL/min.
  • Absorption falls if given with a PPI - separate the doses.
Egyptian brands
Egyptian brandManufacturerIndicative price
CEROXIM 500MG 10 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS > REXCEL33.00 EGP (3.30/unit)
ZIMOCEFOX 500 MG 10 F.C. TABS.BIOMED PHARMACEUTICALS > MASH PREMIERE45.00 EGP (4.50/unit)
ZINACEF 500MG 10 F.C. TABS.GLAXO SMITHKLINE45.00 EGP (4.50/unit)
HIGHCEF 125MG/5ML SUSP. 60ML? strength differs? different route - not oral solidALFACURE PHARMACEUTICALS10.00 EGP
ZIMOCEFOX 125MG/5ML SUSP. 60 ML? strength differs? different route - not oral solidSHIFA MEDICAL PRODUCTS > MASH PREMIERE12.00 EGP

IF PENICILLIN-ALLERGIC

5

DOXYCYCLINE

If penicillin-allergic

2nd line

Strength100 mg

Formoral.solid

Adult dose and duration

100 mg BID (or 200 mg once daily) x 5-7 days

Paediatric dose

CONTRAINDICATED in children under 8 years, because of what it does to the teeth. The Egyptian National Drug Formulary - Antimicrobial 2023, doxycycline monograph, gives the detail: used while the teeth are still forming - the second half of pregnancy, infancy, and childhood up to 8 years - it can stain the teeth permanently, leave the enamel underformed, or discolour tissue, and although long courses carry more of this risk, repeated short courses have done it too.

Dose source

IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis 2012

Why

First-line alternative in penicillin-allergic adult patients

Cautions
  • CONTRAINDICATED in pregnancy and in children < 8 years. The Egyptian National Drug Formulary - Antimicrobial 2023 doxycycline monograph draws the same line: under 8 years the drug is held back for infections severe enough to threaten life, or for the case where nothing better is available.
  • Take with full glass of water while upright to avoid oesophageal ulceration.
  • Doxycycline carries a risk of photosensitivity reactions, so advise sun protection.
Egyptian brands
Egyptian brandManufacturerIndicative price
FARCODOXIN 100MG 10 CAPS.PHARCO11.00 EGP (1.10/unit)
DOXY M.R.100 MG 10 CAPS.ADWIA12.00 EGP (1.20/unit)
GRANUDOXY 100MG 10 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE12.00 EGP (1.20/unit)
DOXYDOX 100 MG 10 CAPS.EIPICO23.00 EGP (2.30/unit)
DOXYMYCIN 100 MG 10 CAPS.EL NILE.30.00 EGP (3.00/unit)
TABOCINE 100MG 10 CAPS.TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA46.00 EGP (4.60/unit)
VIBRAMYCIN 100MG 10 CAPS.PFIZER65.00 EGP (6.50/unit)

SYMPTOM RELIEF AFTER 10 DAYS - give alongside

6

MOMETASONE FUROATE

Symptom relief after 10 days

add-on - not a substitute

Formspray

Adult dose and duration

2 sprays (100 mcg) into EACH nostril twice daily x 14 days

Paediatric dose

Not for under-12s. NG79 recommends this only for adults and children aged 12 years and over. A child under 12 with sinusitis that is not settling needs review, not a nasal steroid on this recommendation.

Choice

Alternatives. NG79 names no particular intranasal steroid. Mometasone leads on lower systemic bioavailability, and 8 Egyptian nasal products carry it including NASONEX.

Dose source

NICE NG79 Sinusitis (acute): antimicrobial prescribing, 27 October 2017, recommendation 1.1.4

Why

NG79 recommendation 1.1.4, for symptoms of around 10 days or more with no improvement - which is most sinusitis seen in primary care, because acute sinusitis is usually viral and antibiotics make little difference to how long it lasts. This is NG79's own figure with no conversion: the guideline says mometasone 200 micrograms twice a day, and the Egyptian sprays are 50 mcg per actuation, so two sprays into each nostril IS 200 micrograms. It is also the cheapest nasal steroid in the register.

Cautions
  • OFF-LABEL. NICE says so inside the recommendation itself - giving a steroid spray for sinusitis falls outside its licence. These sprays are licensed for allergic rhinitis, not for sinusitis.
  • ONLY after around 10 days or more with no improvement. Sinusitis in the first week is expected to be viral and self-limiting; NG79 gives no medicine for it beyond pain relief.
  • 12 years and over only.
  • It may not shorten the illness. NG79 puts it this way: the symptoms may get better, but the illness is unlikely to end any sooner for it - and 17 patients have to be treated for one of them to benefit.
  • Adds to the steroid burden in anyone already taking an oral or inhaled corticosteroid - ask, particularly in asthma.
  • A lower dose is not a gentler version of this - NG79 found doses equivalent to mometasone 200 mcg/day no better than placebo.
  • Epistaxis and headache are the common local effects of any nasal steroid; stop and reassess if bleeding is persistent.
Egyptian brands
Egyptian brandManufacturerIndicative price
SNIFFACAN 50MCG/G NASAL SPRAY 15 MLSIGMA TEC25.20 EGP
TABUNEX 50MCG/G NASAL SPRAY 120 DOSESTABUK PHARMACEUTICAL MANUFACTURING COMPANY > AL ANSAR FOR MARKETING28.80 EGP
NORHINOSE 50MCG/DOSE NASAL SPRAY 120 DOSESEUROPEAN EGYPTIAN PHARM. IND. > AMRIYA90.00 EGP
NASONEX 0.05% NASAL SPRAY 120 DOSESMSD > MERCK SHARP & DOHME SCIENTIFIC OFFICE157.00 EGP
7

FLUTICASONE PROPIONATE

Symptom relief after 10 days

add-on - not a substitute

Formspray

Adult dose and duration

Two spray actuations of fluticasone propionate 50 mcg into each nostril once daily - total daily dose 200 mcg x 14 days

Paediatric dose

Not for under-12s. NG79 recommends this only for adults and children aged 12 years and over. A child under 12 with sinusitis that is not settling needs review, not a nasal steroid on this recommendation.

Dose source

Egyptian National Drug Formulary - Respiratory Medicines 2026, Fluticasone monograph: "Intra-nasal (adults, geriatric, and adolescents 12 years and over): Start with the dose of two spray actuations of (27.5 mcg of fluticasone furoate per spray actuation with a total daily dose of 110 mcg) or of (50 mcg fluticasone propionate with a total daily dose 200mcg) in each nostril once daily (total daily dose)." NICE NG79 recommendation 1.1.4 states a different figure for the same use - "fluticasone 110 micrograms twice a day", 220 mcg a day - and the two documents do not agree; the formulary's 200 mcg daily ceiling is the figure dosed here.

Why

The alternative to mometasone, and the one most Egyptian prescriptions name. The register stocks fluticasone propionate at 50 mcg per spray, and the Egyptian formulary's adult intranasal dose is two spray actuations into each nostril once daily - 200 mcg a day.

Cautions
  • OFF-LABEL. NICE says so inside the recommendation itself - giving a steroid spray for sinusitis falls outside its licence. These sprays are licensed for allergic rhinitis, not for sinusitis.
  • ONLY after around 10 days or more with no improvement. Sinusitis in the first week is expected to be viral and self-limiting; NG79 gives no medicine for it beyond pain relief.
  • 12 years and over only.
  • It may not shorten the illness. NG79 puts it this way: the symptoms may get better, but the illness is unlikely to end any sooner for it - and 17 patients have to be treated for one of them to benefit.
  • Adds to the steroid burden in anyone already taking an oral or inhaled corticosteroid - ask, particularly in asthma.
  • NG79 states that doses equivalent to mometasone 200 mcg a day were no better than placebo, while the Egyptian formulary's own ceiling for intranasal fluticasone propionate is 200 mcg a day. The two documents do not agree, and the formulary's ceiling is the limit applied here.
  • Epistaxis is common (5-12%) and headache (4-16%) per the Egyptian formulary's fluticasone monograph.
Egyptian brands
Egyptian brandManufacturerIndicative price
RHINORELIEF NASAL SUSP. 50 MCG/METERED SPRAY DOSEARAB DRUG COMPANY (ADCO)32.00 EGP
TICANASE 0.05% NASAL SPRAY 12 GMEUROPEAN EGYPTIAN PHARM. IND.70.00 EGP
FLIX NASAL SPRAY 50 MCG/METERED SPRAY DOSEEVA PHARMA76.00 EGP
FLIXONASE 50 MCG/METERED NASAL SPRAY 120 DOSEGLAXO SMITHKLINE133.00 EGP
FLOHALE HFA 250MCG/DOSE AEROSOL 120 DOSESCIPLA LTD. - INDIA > STAR INTERNATIONAL COMPANY95.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.