acute infective rhinitis

Last reviewed 01/2018

Acute infective rhinitis is most commonly experienced as the common cold which, as a viral illness, warrants symptomatic treatment only.

Occasionally, secondary bacterial infection occurs, usually involving Streptococcus pneumoniae or Haemophilus influenzae.

When the nasal discharge is profuse, blockage of the sinus ostia may occur resulting in acute bacterial sinusitis.

• a systematic review concluded (1):
  • there is insufficient evidence of benefit to warrant the use of antibiotics for upper respiratory tract infections in children or adults. Antibiotics cause significant adverse effects in adults. The evidence on acute purulent rhinitis and acute clear rhinitis suggests a benefit for antibiotics for these conditions but their routine use is not recommended
• a meta-analysis concluded that (2):
  • common clinical signs and symptoms cannot identify patients with rhinosinusitis for whom treatment is clearly justified.
  • this meta-analysis states that antibiotics are not justified even if a patient reports symptoms for longer than 7-10 days

Management of acute rhinosinusitis (3):

• avoid antibiotics as 80% resolve in 14 days without; they only offer marginal benefit after 7days number needed to treat (NNT)15
• use adequate analgesia
• consider 7-day delayed or immediate antibiotic when purulent nasal discharge NNT8
• in persistent infection use an agent with anti-anaerobic activity eg. co-amoxiclav
• antibiotic choice - seven day course (adult)
  • amoxicillin 500mg TDS 1g if severe or
  • doxycycline 200mg stat then100mg OD or
  • phenoxymethylpenicillin 500mg QDS
  • for persistent symptoms: co-amoxiclav 625mg TDS
  • note amoxicillin, phenoxymethylpenicillin or co-amoxiclav cannot be used if penicillin allergic

Note that prolonged use of nasal nasal decongestants may predispose to rhinitis medicamentosa

Reference:

• (1) Arroll B, Kenealy T. Antibiotics for the common cold and acute purulent rhinitis. Coochrane Database Syst Rev 2005; (3): CD000247
• (2) Young J et al. Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data. Lancet. 2008 Mar 15;371(9616):908-14
• (3) Public Health England (October 2014). Management of infection guidance for primary care for consultation and local adaptation