{ "schema_version": 1, "kind": "condition", "id": "acute-sinusitis", "name": "Acute bacterial rhinosinusitis", "category": "infectious", "sources": "Egyptian National Drug Formulary - Antimicrobial 2023 (cefuroxime monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (moxifloxacin monograph) · Egyptian National Drug Formulary - Respiratory Medicines 2026, Fluticasone monograph, intra-nasal adults and adolescents 12 years and over · IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis 2012 · NICE NG79 Sinusitis (acute): antimicrobial prescribing, 27 October 2017, recommendation 1.1.4", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Antimicrobial 2023 (cefuroxime monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (moxifloxacin monograph) · Egyptian National Drug Formulary - Respiratory Medicines 2026, Fluticasone monograph, intra-nasal adults and adolescents 12 years and over · IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis 2012 · NICE NG79 Sinusitis (acute): antimicrobial prescribing, 27 October 2017, recommendation 1.1.4 · Acute bacterial rhinosinusitis - disease-level clinical article (acute-sinusitis-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 100, "generic": "Amoxicillin + Clavulanic acid", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 625.0, "adult_dose": "1 g (875/125 mg) BID or 625 mg (500/125 mg) TID", "adult_duration": "5-7 days", "dose_source": "IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis 2012", "rationale": "First-line empiric coverage for S. pneumoniae, H. influenzae, M. catarrhalis", "cautions": [ "Caution in hepatic impairment or history of amoxicillin-clavulanate jaundice.", "Take with food to minimize gastrointestinal adverse effects.", "Discontinue if allergic skin rash develops." ], "peds_mgkg_low": 45.0, "peds_mgkg_high": 90.0, "peds_max_mg": 4000.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "Based on amoxicillin component in 2 divided doses daily", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 450, "high_mg": 900, "capped": false }, { "weight_kg": 20, "low_mg": 900, "high_mg": 1800, "capped": false }, { "weight_kg": 30, "low_mg": 1350, "high_mg": 2700, "capped": false }, { "weight_kg": 40, "low_mg": 1800, "high_mg": 3600, "capped": false } ], "brands": [ { "trade_name": "AUJED 625 MG 12 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA TEC > JEDCO INT. CO. FOR PHARMACEUTICALS", "price_egp": 19.2, "pack_count": 12, "unit_price": 1.6, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "E-MOXCLAV 625MG 10 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 30.0, "pack_count": 10, "unit_price": 3.0, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEXICLAVE 625 MG 12 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > NOVELL PHARMA", "price_egp": 37.5, "pack_count": 12, "unit_price": 3.12, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MAGNABIOTIC 625MG 8 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 37.0, "pack_count": 8, "unit_price": 4.62, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CLAVIMOX 625 MG 12 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 107.0, "pack_count": 12, "unit_price": 8.92, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CURAM 625MG 12 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANDOZ > NOVARTIS", "price_egp": 108.0, "pack_count": 12, "unit_price": 9.0, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGMENTIN 625 MG 10 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP > SMITHKLINE BEECHAM", "price_egp": 117.0, "pack_count": 10, "unit_price": 11.7, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CLAVOCILLIN 625 MG 10 DISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > ORGANOPHARMA", "price_egp": 31.5, "pack_count": null, "unit_price": null, "strength_mg": 625.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR > AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.", "price_egp": 8.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 8.0, "pack_count": null, "unit_price": null, "strength_mg": 156.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "acute-sinusitis" }, { "id": 106, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Acute bacterial rhinosinusitis - disease-level clinical article (acute-sinusitis-clinical.txt)", "rationale": "Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.", "cautions": [ "RED FLAG - Watch for spread of sinus infection to the orbit, bone, or intracranial cavities." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "acute-sinusitis" }, { "id": 101, "generic": "Cefuroxime", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "250 mg or 500 mg twice daily with food", "adult_duration": "10 days", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (cefuroxime monograph)", "rationale": "18 live products. The formulary carries an explicit oral indication - 'Sinusitis, acute bacterial (tablets and oral suspension only): treatment of mild to moderate acute bacterial maxillary sinusitis' - which makes it the correct beta-lactam alternative when amoxicillin-clavulanate has failed or is not tolerated.", "cautions": [ "Take with food - absorption of the tablet falls substantially on an empty stomach.", "Avoid in immediate-type (anaphylactic) penicillin allergy; cross-reactivity with other beta-lactams.", "The formulary places cefuroxime in the WATCH group - do not use it ahead of amoxicillin-clavulanate.", "Most acute rhinosinusitis is viral; reserve any antibiotic for symptoms beyond 10 days, double worsening, or severe systemic features.", "Reduce the frequency to every 12 or 24 hours if creatinine clearance is below 20 mL/min.", "Absorption falls if given with a PPI - separate the doses." ], "peds_mgkg_low": 20.0, "peds_mgkg_high": 30.0, "peds_max_mg": 1000.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "Mild to moderate infection: 20-30 mg/kg/day orally divided twice daily, maximum 500 mg per dose (so 1000 mg/day). Oral suspension 125 mg/5 mL and 250 mg/5 mL, licensed from 3 months.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "3 months and over", "age_min_months": 3, "age_max_months": 216, "dose_text": "Mild to moderate infection: 20 to 30 mg/kg/day by mouth divided twice daily, maximum 500 mg per dose. Suspension licensed from 3 months." } ], "peds_doses": [ { "weight_kg": 10, "low_mg": 200, "high_mg": 300, "capped": false }, { "weight_kg": 20, "low_mg": 400, "high_mg": 600, "capped": false }, { "weight_kg": 30, "low_mg": 600, "high_mg": 900, "capped": false }, { "weight_kg": 40, "low_mg": 800, "high_mg": 1000, "capped": true } ], "brands": [ { "trade_name": "CEROXIM 500MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > REXCEL", "price_egp": 33.0, "pack_count": 10, "unit_price": 3.3, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZIMOCEFOX 500 MG 10 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BIOMED PHARMACEUTICALS > MASH PREMIERE", "price_egp": 45.0, "pack_count": 10, "unit_price": 4.5, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZINACEF 500MG 10 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 45.0, "pack_count": 10, "unit_price": 4.5, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "HIGHCEF 125MG/5ML SUSP. 60ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALFACURE PHARMACEUTICALS", "price_egp": 10.0, "pack_count": null, "unit_price": null, "strength_mg": 125.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "ZIMOCEFOX 125MG/5ML SUSP. 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SHIFA MEDICAL PRODUCTS > MASH PREMIERE", "price_egp": 12.0, "pack_count": null, "unit_price": null, "strength_mg": 125.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "acute-sinusitis" }, { "id": 102, "generic": "Doxycycline", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 100.0, "adult_dose": "100 mg BID (or 200 mg once daily)", "adult_duration": "5-7 days", "dose_source": "IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis 2012", "rationale": "First-line alternative in penicillin-allergic adult patients", "cautions": [ "CONTRAINDICATED in pregnancy and in children < 8 years. The Egyptian National Drug Formulary - Antimicrobial 2023 doxycycline monograph draws the same line: under 8 years the drug is held back for infections severe enough to threaten life, or for the case where nothing better is available.", "Take with full glass of water while upright to avoid oesophageal ulceration.", "Doxycycline carries a risk of photosensitivity reactions, so advise sun protection." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "CONTRAINDICATED in children under 8 years, because of what it does to the teeth. The Egyptian National Drug Formulary - Antimicrobial 2023, doxycycline monograph, gives the detail: used while the teeth are still forming - the second half of pregnancy, infancy, and childhood up to 8 years - it can stain the teeth permanently, leave the enamel underformed, or discolour tissue, and although long courses carry more of this risk, repeated short courses have done it too.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "FARCODOXIN 100MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 11.0, "pack_count": 10, "unit_price": 1.1, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOXY M.R.100 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ADWIA", "price_egp": 12.0, "pack_count": 10, "unit_price": 1.2, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GRANUDOXY 100MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE", "price_egp": 12.0, "pack_count": 10, "unit_price": 1.2, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOXYDOX 100 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 23.0, "pack_count": 10, "unit_price": 2.3, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOXYMYCIN 100 MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 30.0, "pack_count": 10, "unit_price": 3.0, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TABOCINE 100MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 46.0, "pack_count": 10, "unit_price": 4.6, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VIBRAMYCIN 100MG 10 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PFIZER", "price_egp": 65.0, "pack_count": 10, "unit_price": 6.5, "strength_mg": 100.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "acute-sinusitis" }, { "id": 103, "generic": "Moxifloxacin", "line": 4, "is_adjunct": false, "form": "oral.solid", "strength_mg": 400.0, "adult_dose": "400 mg once daily by mouth", "adult_duration": "Not fixed in the source - the formulary advises individualising duration by clinical response, extent of disease and toxicity", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (moxifloxacin monograph)", "rationale": "53 live products, and the formulary lists acute bacterial rhinosinusitis explicitly. Placed at line 4 to match the formulary's own limitation of use rather than at the line its market share would suggest.", "cautions": [ "The formulary's own limitation of use: reserve moxifloxacin for acute sinusitis only in patients who have no alternative treatment option.", "Disabling and potentially irreversible reactions: tendinopathy and tendon rupture, peripheral neuropathy, and CNS effects - stop at the first tendon pain or new paraesthesia.", "There is an aortic aneurysm and dissection risk - avoid in a patient with known aortic disease, Marfan syndrome, or uncontrolled hypertension.", "QT prolongation - avoid with other QT-prolonging drugs and in uncorrected hypokalaemia.", "Absorption is destroyed by antacids, iron, calcium, zinc and sucralfate - separate by at least 4 hours.", "No dose adjustment is needed in renal or hepatic impairment, but use with caution in liver disease because of the QT risk." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The formulary states fluoroquinolones are not routinely first-line in children and gives no paediatric sinusitis dose. Do not use in a child for sinusitis.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "MOXILABACT 400 MG 5 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 30.6, "pack_count": 5, "unit_price": 6.12, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GASTAMOXACINE 400MG 7 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES > GAST PHARMA GROUP-EGYPT", "price_egp": 45.0, "pack_count": 7, "unit_price": 6.43, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MERAMERIX 400MG 5 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARMED HEALTHCARE > ABBOTT LABORATORIES", "price_egp": 40.5, "pack_count": 5, "unit_price": 8.1, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IDELOX 400MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA", "price_egp": 116.0, "pack_count": 10, "unit_price": 11.6, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PRIMOXIZAR 400 MG 5 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARMA CURE PHARMACEUTICALS > PHARMA CURE", "price_egp": 80.0, "pack_count": 5, "unit_price": 16.0, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MOXIFLOX 400 MG 10 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 180.0, "pack_count": 10, "unit_price": 18.0, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MOXAVIDEX 400 MG 10 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > UTOPIA", "price_egp": 184.0, "pack_count": 10, "unit_price": 18.4, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MOXAVIDEX 400 MG 5 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > UTOPIA", "price_egp": 92.0, "pack_count": 5, "unit_price": 18.4, "strength_mg": 400.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MOXIFLOXACIN-EL NILE 400MG/250ML SOL. FOR INF.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 80.5, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "MOXITRIX 400MG/250ML SOL. FOR INF.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB CO. FOR MEDICAL PRODUCTS > SPIMACO MISR", "price_egp": 86.0, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "acute-sinusitis" }, { "id": 104, "generic": "Mometasone furoate", "line": 1, "is_adjunct": true, "form": "spray", "strength_mg": null, "adult_dose": "2 sprays (100 mcg) into EACH nostril twice daily", "adult_duration": "14 days", "dose_source": "NICE NG79 Sinusitis (acute): antimicrobial prescribing, 27 October 2017, recommendation 1.1.4", "rationale": "NG79 recommendation 1.1.4, for symptoms of around 10 days or more with no improvement - which is most sinusitis seen in primary care, because acute sinusitis is usually viral and antibiotics make little difference to how long it lasts. This is NG79's own figure with no conversion: the guideline says mometasone 200 micrograms twice a day, and the Egyptian sprays are 50 mcg per actuation, so two sprays into each nostril IS 200 micrograms. It is also the cheapest nasal steroid in the register.", "cautions": [ "OFF-LABEL. NICE says so inside the recommendation itself - giving a steroid spray for sinusitis falls outside its licence. These sprays are licensed for allergic rhinitis, not for sinusitis.", "ONLY after around 10 days or more with no improvement. Sinusitis in the first week is expected to be viral and self-limiting; NG79 gives no medicine for it beyond pain relief.", "12 years and over only.", "It may not shorten the illness. NG79 puts it this way: the symptoms may get better, but the illness is unlikely to end any sooner for it - and 17 patients have to be treated for one of them to benefit.", "Adds to the steroid burden in anyone already taking an oral or inhaled corticosteroid - ask, particularly in asthma.", "A lower dose is not a gentler version of this - NG79 found doses equivalent to mometasone 200 mcg/day no better than placebo.", "Epistaxis and headache are the common local effects of any nasal steroid; stop and reassess if bleeding is persistent." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not for under-12s. NG79 recommends this only for adults and children aged 12 years and over. A child under 12 with sinusitis that is not settling needs review, not a nasal steroid on this recommendation.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "SNIFFACAN 50MCG/G NASAL SPRAY 15 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA TEC", "price_egp": 25.2, "pack_count": null, "unit_price": null, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TABUNEX 50MCG/G NASAL SPRAY 120 DOSES", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > AL ANSAR FOR MARKETING", "price_egp": 28.8, "pack_count": null, "unit_price": null, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NORHINOSE 50MCG/DOSE NASAL SPRAY 120 DOSES", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND. > AMRIYA", "price_egp": 90.0, "pack_count": null, "unit_price": null, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NASONEX 0.05% NASAL SPRAY 120 DOSES", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MSD > MERCK SHARP & DOHME SCIENTIFIC OFFICE", "price_egp": 157.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "acute-sinusitis" }, { "id": 105, "generic": "Fluticasone propionate", "line": 1, "is_adjunct": true, "form": "spray", "strength_mg": null, "adult_dose": "Two spray actuations of fluticasone propionate 50 mcg into each nostril once daily - total daily dose 200 mcg", "adult_duration": "14 days", "dose_source": "Egyptian National Drug Formulary - Respiratory Medicines 2026, Fluticasone monograph: \"Intra-nasal (adults, geriatric, and adolescents 12 years and over): Start with the dose of two spray actuations of (27.5 mcg of fluticasone furoate per spray actuation with a total daily dose of 110 mcg) or of (50 mcg fluticasone propionate with a total daily dose 200mcg) in each nostril once daily (total daily dose).\" NICE NG79 recommendation 1.1.4 states a different figure for the same use - \"fluticasone 110 micrograms twice a day\", 220 mcg a day - and the two documents do not agree; the formulary's 200 mcg daily ceiling is the figure dosed here.", "rationale": "The alternative to mometasone, and the one most Egyptian prescriptions name. The register stocks fluticasone propionate at 50 mcg per spray, and the Egyptian formulary's adult intranasal dose is two spray actuations into each nostril once daily - 200 mcg a day.", "cautions": [ "OFF-LABEL. NICE says so inside the recommendation itself - giving a steroid spray for sinusitis falls outside its licence. These sprays are licensed for allergic rhinitis, not for sinusitis.", "ONLY after around 10 days or more with no improvement. Sinusitis in the first week is expected to be viral and self-limiting; NG79 gives no medicine for it beyond pain relief.", "12 years and over only.", "It may not shorten the illness. NG79 puts it this way: the symptoms may get better, but the illness is unlikely to end any sooner for it - and 17 patients have to be treated for one of them to benefit.", "Adds to the steroid burden in anyone already taking an oral or inhaled corticosteroid - ask, particularly in asthma.", "NG79 states that doses equivalent to mometasone 200 mcg a day were no better than placebo, while the Egyptian formulary's own ceiling for intranasal fluticasone propionate is 200 mcg a day. The two documents do not agree, and the formulary's ceiling is the limit applied here.", "Epistaxis is common (5-12%) and headache (4-16%) per the Egyptian formulary's fluticasone monograph." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not for under-12s. NG79 recommends this only for adults and children aged 12 years and over. A child under 12 with sinusitis that is not settling needs review, not a nasal steroid on this recommendation.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "RHINORELIEF NASAL SUSP. 50 MCG/METERED SPRAY DOSE", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 32.0, "pack_count": null, "unit_price": null, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TICANASE 0.05% NASAL SPRAY 12 GM", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EUROPEAN EGYPTIAN PHARM. IND.", "price_egp": 70.0, "pack_count": null, "unit_price": null, "strength_mg": 12000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLIX NASAL SPRAY 50 MCG/METERED SPRAY DOSE", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 76.0, "pack_count": null, "unit_price": null, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLIXONASE 50 MCG/METERED NASAL SPRAY 120 DOSE", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 133.0, "pack_count": null, "unit_price": null, "strength_mg": 0.05, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLOHALE HFA 250MCG/DOSE AEROSOL 120 DOSES", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CIPLA LTD. - INDIA > STAR INTERNATIONAL COMPANY", "price_egp": 95.0, "pack_count": null, "unit_price": null, "strength_mg": 0.25, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "acute-sinusitis" } ] }