Acute Rhinosinusitis Severity (EPOS Criteria)
Classifies acute rhinosinusitis (EPOS 2020) as viral, post-viral or acute bacterial, and flags complications, to guide antibiotic prescribing.
Score interpretation
Symptoms under 10 days and not worsening after day 5 (EPOS 2020).
→ Self-care: analgesia, saline irrigation; no antibiotic (NICE NG79). Review if symptoms persist beyond 10 days or worsen.
Symptoms worse after day 5 or persisting beyond 10 days, without 3 bacterial signs (EPOS 2020).
→ No antibiotic or a back-up antibiotic prescription (NICE NG79); consider a high-dose nasal corticosteroid for 14 days (age 12 and over); safety-net advice.
At least 3 of: discoloured discharge, severe local pain, fever > 38 °C, raised ESR/CRP, double sickening.
→ EPOS 2020 reserves antibiotics for ABRS. NICE NG79: immediate antibiotic if systemically very unwell, signs of a more serious illness or high risk of complications; otherwise no antibiotic or a back-up prescription. Adults: amoxicillin 500mg TDS 5 days. Children: use a children's formulary. Intranasal corticosteroids; ENT referral if recurrent.
Red-flag signs of orbital or intracranial spread (EPOS 2020).
→ Same-day hospital assessment: urgent ENT (and ophthalmology / neurosurgery as indicated), CT sinuses with contrast, IV antibiotics.
Interpretation bands for the Rhinosinusitis Score. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Morphine (Orthopaedic Acute Pain) · Opioid Analgesic — Strong
- Dexketoprofen (Acute Musculoskeletal Pain) · NSAID — Non-selective COX Inhibitor (S-enantiomer of Ketoprofen)
- Glyceryl Trinitrate (Sublingual / IV) · Nitrate / Acute Angina
- Dobutamine (Acute HF / Stress Echo) · Inotrope / Acute Heart Failure
- Milrinone · Inodilator / Acute Heart Failure
- Adult Upper Airway Obstruction (Stridor) · DAS 2015 unanticipated difficult airway; RCEM
- Epistaxis Management · ENT-UK / NICE
- Acute Otitis Media · NICE NG91 2018
- Tonsillitis and Sore Throat · NICE NG84 2018
- Benign Paroxysmal Positional Vertigo · NICE CG124 / AAO-HNS Guidelines
- Acute Rhinosinusitis · NICE NG79 2017 / EPOS 2020
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.