Sinusitis, bacterial, complicated

J01.0-4/J01.8-9

DESCRIPTION

Acute bacterial sinusitis complicated by extension to the orbit or intracranially.

Extension to the orbit causes orbital cellulitis or orbital periosteal abscess, both of which may present with pain on eye movement, partial or complete visual loss (which can be irreversible), ophthalmoplegia, and proptosis. Eyelid oedema and erythema is usually present, but external signs of inflammation may be absent.

Intracranial extension may cause meningitis, subdural empyema, brain abscess, or thrombosis of cavernous sinus/cortical veins.

In immunosuppressed or diabetic patients presenting with features of sinusitis consider fungal infections such as mucormycosis. Features suggesting mucormycosis include necrosis of the nasal or palatal mucosa, and orbital or cerebral involvement.

MEDICINE TREATMENT

  • Ceftriaxone, IV, 2 g 12 hourly and refer .

Pain:

  • Paracetamol, oral, 1 g 4–6 hourly when required.
    • Maximum dose: 15 mg/kg/dose.
    • Maximum daily dose: 4 g in 24 hours.

LoEIII

REFERRAL

Urgent

  • Proptosis.
  • Ophthalmoplegia.
  • Suspected mucormycosis, especially in immunocompromised patients.

Non-urgent

  • After initiating antimicrobial therapy, refer for a CT scan, to a centre where an appropriate surgical specialist, i.e. ophthalmologist, ENT specialist or neurosurgeon, is available.
  • Suspected fungal sinusitis (other than mucormycosis).