Acute sinusitis — the congestion, facial pain, and pressure that follows a cold — is one of the most common reasons people contact their GP. According to the Royal College of General Practitioners, upper respiratory tract infections including sinusitis account for millions of primary care consultations each year in England.
Most cases resolve without antibiotics. But when they do not, getting treatment has traditionally meant waiting for a GP appointment — often for a condition that makes concentrating at work or sleeping properly difficult in the meantime.
Under the NHS Pharmacy First service, community pharmacists in England can now assess and treat acute sinusitis, including supplying prescription-only antibiotics where the clinical criteria are met.
What Is Acute Sinusitis?
Acute sinusitis is inflammation of the sinuses — the air-filled spaces behind the forehead, cheeks, and eyes. It most commonly develops after a viral upper respiratory tract infection (a cold) and causes:
- Facial pain or pressure, often worse when bending forward
- A blocked or runny nose, often with yellow or green discharge
- Reduced sense of smell
- Headache
- Sometimes a fever, particularly if the infection is bacterial
Most sinusitis is viral and resolves within two to three weeks. Bacterial sinusitis — which may warrant antibiotics — typically presents with symptoms that worsen after an initial improvement, or that persist beyond ten days without improvement.
How Pharmacy First Works for Sinusitis
When you visit a pharmacy with sinusitis symptoms, the pharmacist will:
- Take a history — when symptoms started, whether they followed a cold, and whether they are improving or worsening
- Assess severity — checking for signs that suggest bacterial infection or complications
- Recommend treatment — either self-care measures for viral sinusitis or antibiotics for bacterial cases
Self-care (most cases)
For viral sinusitis, the pharmacist will typically recommend:
| Treatment | Purpose |
|---|---|
| Paracetamol or ibuprofen | Pain relief and reducing inflammation |
| Saline nasal irrigation | Clearing congestion |
| Warm compresses | Relieving facial pressure |
| Steam inhalation | Easing congestion (with care to avoid scalds) |
| Decongestant nasal sprays (short-term) | Reducing nasal blockage (maximum 5–7 days) |
Antibiotics (when criteria are met)
If symptoms suggest bacterial sinusitis — for instance, symptoms worsening after five days or not improving after ten days — the pharmacist can prescribe:
| Antibiotic | Typical course |
|---|---|
| Phenoxymethylpenicillin 500mg | Four times daily for five days |
| Amoxicillin 500mg (alternative) | Three times daily for five days |
| Clarithromycin 500mg (penicillin allergy) | Twice daily for five days |
| Doxycycline 200mg then 100mg (alternative) | Once daily, loading dose then five days |
The pharmacist follows NICE guidance (NG79: Sinusitis — acute antimicrobial prescribing) in determining whether antibiotics are appropriate.
When to See a Pharmacist vs a GP
Go to the pharmacy if:
- Your symptoms are consistent with uncomplicated sinusitis
- You are otherwise fit and healthy
- Symptoms have lasted less than 12 weeks
See a GP or call 111 if:
- There is severe or worsening facial pain, particularly around one eye
- You have high fever (above 38.5°C) or feel significantly unwell
- Symptoms keep recurring (four or more episodes per year may indicate chronic sinusitis)
- You have a weakened immune system
- Symptoms have persisted for more than 12 weeks (this may be chronic sinusitis, which requires different management)
Seek emergency care if:
- There is swelling or redness around the eye
- Changes in vision (double vision or reduced vision)
- Severe headache that is different from usual sinus pain
- These can indicate rare but serious complications such as orbital cellulitis
What the Pharmacist Cannot Do
Under Pharmacy First, the pharmacist can treat straightforward acute sinusitis. They cannot:
- Order imaging (CT scans or X-rays)
- Prescribe nasal steroid sprays for chronic sinusitis (this requires a GP)
- Manage recurrent or chronic sinusitis, which may need ENT referral
- Treat sinusitis in children under one year (GP referral required)
If the pharmacist determines that your case falls outside the Pharmacy First scope, they will refer you to a GP — often with a clinical note that can expedite your appointment.
Finding a Pharmacy
Over 13,000 community pharmacies across England participate in Pharmacy First. Use PharmSee's pharmacy search to find your nearest pharmacy, or check the location tool to see pharmacy density around your postcode. Current pharmacy job listings — reflecting where pharmacies are actively staffing — are available on the jobs page.
Sources: NHS England Pharmacy First service specification; NICE guideline NG79 — Sinusitis (acute): antimicrobial prescribing; NICE CKS — Sinusitis; NHS.uk — Sinusitis.