# Acute bacterial rhinosinusitis - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Amoxicillin + Clavulanic acid — 625 mg — oral.solid - Referral & safety-netting (no drug therapy) - Cefuroxime — 500 mg — oral.solid - Doxycycline — 100 mg — oral.solid - Moxifloxacin — 400 mg — oral.solid - Mometasone furoate — spray - Fluticasone propionate — spray ## Complete treatment card ```text ACUTE BACTERIAL RHINOSINUSITIS 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 Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Acute Sinusitis" - disease-level clinical article Status 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] Adult 1 g (875/125 mg) BID or 625 mg (500/125 mg) TID x 5-7 days Peds 45-90 mg/kg/day [child max 4000 mg] (Based on amoxicillin component in 2 divided doses daily) 3kg -> 135-270 mg/day 4kg -> 180-360 mg/day 5kg -> 225-450 mg/day 6kg -> 270-540 mg/day 7kg -> 315-630 mg/day 8kg -> 360-720 mg/day 9kg -> 405-810 mg/day 10kg -> 450-900 mg/day 11kg -> 495-990 mg/day 12kg -> 540-1080 mg/day 13kg -> 585-1170 mg/day 14kg -> 630-1260 mg/day 15kg -> 675-1350 mg/day 16kg -> 720-1440 mg/day 17kg -> 765-1530 mg/day 18kg -> 810-1620 mg/day 19kg -> 855-1710 mg/day 20kg -> 900-1800 mg/day 21kg -> 945-1890 mg/day 22kg -> 990-1980 mg/day 23kg -> 1035-2070 mg/day 24kg -> 1080-2160 mg/day 25kg -> 1125-2250 mg/day 26kg -> 1170-2340 mg/day 27kg -> 1215-2430 mg/day 28kg -> 1260-2520 mg/day 29kg -> 1305-2610 mg/day 30kg -> 1350-2700 mg/day 31kg -> 1395-2790 mg/day 32kg -> 1440-2880 mg/day 33kg -> 1485-2970 mg/day 34kg -> 1530-3060 mg/day 35kg -> 1575-3150 mg/day 36kg -> 1620-3240 mg/day 37kg -> 1665-3330 mg/day 38kg -> 1710-3420 mg/day 39kg -> 1755-3510 mg/day 40kg -> 1800-3600 mg/day 41kg -> 1845-3690 mg/day 42kg -> 1890-3780 mg/day 43kg -> 1935-3870 mg/day 44kg -> 1980-3960 mg/day 45kg -> 2025-4000 mg/day (upper capped) 46kg -> 2070-4000 mg/day (upper capped) 47kg -> 2115-4000 mg/day (upper capped) 48kg -> 2160-4000 mg/day (upper capped) 49kg -> 2205-4000 mg/day (upper capped) 50kg -> 2250-4000 mg/day (upper capped) Source IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis 2012 Why First-line empiric coverage for S. pneumoniae, H. influenzae, M. catarrhalis Caution Caution in hepatic impairment or history of amoxicillin-clavulanate jaundice. Take with food to minimize gastrointestinal adverse effects. Discontinue if allergic skin rash develops. Egypt AUJED 625 MG 12 F.C. TAB. SIGMA TEC > J... 19.20 EGP (1.60/unit) E-MOXCLAV 625MG 10 TAB. EIPICO 30.00 EGP (3.00/unit) DEXICLAVE 625 MG 12 F.C. TABS. RAMEDA > NOVE... 37.50 EGP (3.12/unit) MAGNABIOTIC 625MG 8 TAB. SEDICO 37.00 EGP (4.62/unit) CLAVIMOX 625 MG 12 F.C.TABS. PHARCO 107.00 EGP (8.92/unit) CURAM 625MG 12 F.C.TAB. SANDOZ > NOVA... 108.00 EGP (9.00/unit) AUGMENTIN 625 MG 10 F.C.TABS. MUP > SMITHKL... 117.00 EGP (11.70/unit) CLAVOCILLIN 625 MG 10 DISPERSIBLE TABS. RAMEDA > ORGANOPHARMA 31.50 EGP LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral solid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution RED FLAG - Watch for spread of sinus infection to the orbit, bone, or intracranial cavities. 3. MOXIFLOXACIN [alternative] Adult 400 mg once daily by mouth - Not fixed in the source - the formulary advises individualising duration by clinical response, extent of disease and toxicity Peds 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. 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. Caution 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. Egypt MOXILABACT 400 MG 5 F.C. TABS. KAHIRA 30.60 EGP (6.12/unit) GASTAMOXACINE 400MG 7 F.C. TAB. MEDIZEN PHARM... 45.00 EGP (6.43/unit) MERAMERIX 400MG 5 F.C.TAB. PHARMED HEALT... 40.50 EGP (8.10/unit) IDELOX 400MG 10 F.C. TAB. RAMEDA 116.00 EGP (11.60/unit) PRIMOXIZAR 400 MG 5 F.C. TAB. PHARMA CURE P... 80.00 EGP (16.00/unit) MOXIFLOX 400 MG 10 F.C.TABS. EVA PHARMA 180.00 EGP (18.00/unit) MOXAVIDEX 400 MG 10 F.C.TABS. FUTURE PHARMA... 184.00 EGP (18.40/unit) MOXAVIDEX 400 MG 5 F.C.TABS. FUTURE PHARMA... 92.00 EGP (18.40/unit) MOXIFLOXACIN-EL NILE 400MG/250ML SOL. FOR INF. EL NILE. 80.50 EGP -> ? strength differs, ? different route - not oral solid MOXITRIX 400MG/250ML SOL. FOR INF. ARAB CO. FOR MEDICAL PRODUCTS > SPIMA... 86.00 EGP -> ? strength differs, ? different route - not oral solid SECOND-LINE ANTIBIOTIC 4. CEFUROXIME [2nd line] Adult 250 mg or 500 mg twice daily with food x 10 days Peds 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.) 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. 3kg -> 60-90 mg/day 4kg -> 80-120 mg/day 5kg -> 100-150 mg/day 6kg -> 120-180 mg/day 7kg -> 140-210 mg/day 8kg -> 160-240 mg/day 9kg -> 180-270 mg/day 10kg -> 200-300 mg/day 11kg -> 220-330 mg/day 12kg -> 240-360 mg/day 13kg -> 260-390 mg/day 14kg -> 280-420 mg/day 15kg -> 300-450 mg/day 16kg -> 320-480 mg/day 17kg -> 340-510 mg/day 18kg -> 360-540 mg/day 19kg -> 380-570 mg/day 20kg -> 400-600 mg/day 21kg -> 420-630 mg/day 22kg -> 440-660 mg/day 23kg -> 460-690 mg/day 24kg -> 480-720 mg/day 25kg -> 500-750 mg/day 26kg -> 520-780 mg/day 27kg -> 540-810 mg/day 28kg -> 560-840 mg/day 29kg -> 580-870 mg/day 30kg -> 600-900 mg/day 31kg -> 620-930 mg/day 32kg -> 640-960 mg/day 33kg -> 660-990 mg/day 34kg -> 680-1000 mg/day (upper capped) 35kg -> 700-1000 mg/day (upper capped) 36kg -> 720-1000 mg/day (upper capped) 37kg -> 740-1000 mg/day (upper capped) 38kg -> 760-1000 mg/day (upper capped) 39kg -> 780-1000 mg/day (upper capped) 40kg -> 800-1000 mg/day (upper capped) 41kg -> 820-1000 mg/day (upper capped) 42kg -> 840-1000 mg/day (upper capped) 43kg -> 860-1000 mg/day (upper capped) 44kg -> 880-1000 mg/day (upper capped) 45kg -> 900-1000 mg/day (upper capped) 46kg -> 920-1000 mg/day (upper capped) 47kg -> 940-1000 mg/day (upper capped) 48kg -> 960-1000 mg/day (upper capped) 49kg -> 980-1000 mg/day (upper capped) 50kg -> 1000 mg/day (capped) 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. Caution 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. Egypt CEROXIM 500MG 10 F.C. TAB. GLOBAL NAPI P... 33.00 EGP (3.30/unit) ZIMOCEFOX 500 MG 10 F.C. TABS. BIOMED PHARMA... 45.00 EGP (4.50/unit) ZINACEF 500MG 10 F.C. TABS. GLAXO SMITHKLINE 45.00 EGP (4.50/unit) HIGHCEF 125MG/5ML SUSP. 60ML ALFACURE PHAR... 10.00 EGP -> ? strength differs, ? different route - not oral solid ZIMOCEFOX 125MG/5ML SUSP. 60 ML SHIFA MEDICAL... 12.00 EGP -> ? strength differs, ? different route - not oral solid IF PENICILLIN-ALLERGIC 5. DOXYCYCLINE [2nd line] Adult 100 mg BID (or 200 mg once daily) x 5-7 days Peds 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. Source IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis 2012 Why First-line alternative in penicillin-allergic adult patients Caution 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. Egypt FARCODOXIN 100MG 10 CAPS. PHARCO 11.00 EGP (1.10/unit) DOXY M.R.100 MG 10 CAPS. ADWIA 12.00 EGP (1.20/unit) GRANUDOXY 100MG 10 F.C. TAB. GLOBAL NAPI P... 12.00 EGP (1.20/unit) DOXYDOX 100 MG 10 CAPS. EIPICO 23.00 EGP (2.30/unit) DOXYMYCIN 100 MG 10 CAPS. EL NILE. 30.00 EGP (3.00/unit) TABOCINE 100MG 10 CAPS. TABUK PHARMAC... 46.00 EGP (4.60/unit) VIBRAMYCIN 100MG 10 CAPS. PFIZER 65.00 EGP (6.50/unit) SYMPTOM RELIEF AFTER 10 DAYS - give alongside 6. MOMETASONE FUROATE [add-on - not a substitute] Adult 2 sprays (100 mcg) into EACH nostril twice daily x 14 days Peds 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. 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. Caution 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. Egypt SNIFFACAN 50MCG/G NASAL SPRAY 15 ML SIGMA TEC 25.20 EGP TABUNEX 50MCG/G NASAL SPRAY 120 DOSES TABUK PHARMACEUTICAL MANUFACTURING... 28.80 EGP NORHINOSE 50MCG/DOSE NASAL SPRAY 120 DOSES EUROPEAN EGYPTIAN PHARM. IND.... 90.00 EGP NASONEX 0.05% NASAL SPRAY 120 DOSES MSD > MERCK SHARP & DOHME SCIENTIFIC... 157.00 EGP 7. FLUTICASONE PROPIONATE [add-on - not a substitute] Adult Two spray actuations of fluticasone propionate 50 mcg into each nostril once daily - total daily dose 200 mcg x 14 days Peds 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. 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. Caution 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. Egypt RHINORELIEF NASAL SUSP. 50 MCG/METERED SPRAY DOSE ARAB DRUG COMPANY (ADCO) 32.00 EGP TICANASE 0.05% NASAL SPRAY 12 GM EUROPEAN EGYP... 70.00 EGP FLIX NASAL SPRAY 50 MCG/METERED SPRAY DOSE EVA PHARMA 76.00 EGP FLIXONASE 50 MCG/METERED NASAL SPRAY 120 DOSE GLAXO SMITHKLINE 133.00 EGP FLOHALE HFA 250MCG/DOSE AEROSOL 120 DOSES CIPLA LTD. - INDIA > STAR INTE... 95.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)