Most acute rhinosinusitis in adults is viral and settles within 7 to 10 days. A bacterial cause becomes more likely in three patterns: symptoms lasting beyond 10 days without improvement, severe onset with high fever and facial pain for three or more days, or 'double worsening' — getting better and then clearly worse again.
Outside those patterns, antibiotics add side effects without shortening the illness much. Saline irrigation, analgesia and an intranasal steroid are the usual supportive measures. Red flags — periorbital swelling, visual change, severe headache or confusion — need urgent assessment rather than a prescription.
- Consider antibiotics only for symptoms beyond 10 days, severe onset, or double worsening.
- Offer saline irrigation, analgesia and intranasal steroids for the rest.
- Refer urgently for periorbital swelling, visual change, severe headache or confusion.
- Tell patients that discoloured mucus alone does not mean a bacterial infection.
Why it matters
Sinusitis remains one of the commonest reasons for avoidable antibiotic prescriptions in adults.
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