ENT Management Pathways

Question 1

At what point would you consider prescribing intranasal corticosteroids for acute sinusitis?

Answer 1

If symptoms have been present for more than 10 days

Question 2

When would you prescribe an antibiotic for acute sinusitis, and what one is first and second line?

Answer 2

‘systemically very unwell, signs and symptoms of a more serious illness, or at high-risk of complications’ - BNF
Or present for more than 10 days (antibiotic person)
Penicillin V first line, doxycycline 2nd line (5 days)

Question 3

When would you prescribe an antibiotic for otitis media?

Answer 3

Antibiotics should be prescribed immediately if:
Symptoms lasting more than 4 days or not improving
Systemically unwell but not requiring admission
Immunocompromise or high risk of complications secondary to significant heart, lung, kidney, liver, or neuromuscular disease
Younger than 2 years with bilateral otitis media
Otitis media with perforation and/or discharge in the canal

Question 4

What antibiotic would you give for otitis media?

Answer 4

Amoxicillin 5 days
Clarithromycin if allergic