{ "schema_version": 1, "kind": "condition", "id": "chronic-rhinosinusitis", "name": "Chronic Rhinosinusitis", "category": "chronic", "sources": "Chronic Sinusitis - StatPearls, updated 12 January 2026 - https://www.ncbi.nlm.nih.gov/books/NBK441934/ · EPOS 2020 - European Position Paper on Rhinosinusitis and Nasal Polyps, executive summary, adult chronic rhinosinusitis treatment table (epos-2020-executive-summary.pdf) · Egyptian National Drug Formulary - Respiratory Medicines 2026, Fluticasone monograph, intra-nasal adults and adolescents 12 years and over", "review_status": "reviewed", "verified_against": "Chronic Sinusitis - StatPearls, updated 12 January 2026 - https://www.ncbi.nlm.nih.gov/books/NBK441934/ · EPOS 2020 - European Position Paper on Rhinosinusitis and Nasal Polyps, executive summary, adult chronic rhinosinusitis treatment table (epos-2020-executive-summary.pdf) · Egyptian National Drug Formulary - Respiratory Medicines 2026, Fluticasone monograph, intra-nasal adults and adolescents 12 years and over", "verified_date": "2026-08", "treatments": [ { "id": 457, "generic": "Fluticasone propionate", "line": 1, "is_adjunct": false, "form": "spray", "strength_mg": null, "adult_dose": "2 sprays (100 mcg) into EACH nostril once daily", "adult_duration": "long-term, reassess at 12 weeks", "dose_source": "Egyptian National Drug Formulary - Respiratory Medicines 2026, Fluticasone monograph, intra-nasal adults and adolescents 12 years and over", "rationale": "An intranasal corticosteroid is the foundation of chronic rhinosinusitis treatment. StatPearls puts saline and a nasal steroid together as the pair most people gain from when they are used steadily. The dose is the Egyptian formulary's standard adult intranasal one, not a higher one: in acute sinusitis NICE recommends a high dose for 14 days, but this is continuous treatment and no document held here recommends a high dose for it.", "cautions": [ "TWELVE WEEKS is the diagnosis, not a long cold. StatPearls asks for symptoms lasting 12 weeks or more, plus two or more of: thick or discoloured drainage, nasal congestion, facial pain or pressure, reduced sense of smell - AND objective evidence of mucosal disease on endoscopy or CT.", "This is NOT acute sinusitis and is not treated with a course of antibiotics. If you are reaching for amoxicillin-clavulanate, re-read the duration.", "Off-label on the Egyptian label, which indicates the nasal spray for allergic rhinitis. The indication in chronic rhinosinusitis is from the guideline, not the product licence.", "It works slowly. Judge it at 8-12 weeks of CONSISTENT use, not after two weeks - most failures are adherence, not drug failure.", "Unilateral symptoms, bleeding, facial numbness or orbital signs are not chronic rhinosinusitis. Refer.", "Objective confirmation (endoscopy or CT) is part of the definition - a diagnosis made on symptoms alone will include a lot of allergic rhinitis and some nasal polyps." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children 4-12 years: one spray into each nostril once daily per the Egyptian formulary. Chronic rhinosinusitis in a child warrants ENT assessment rather than open-ended treatment in primary care.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "4 to 12 years", "age_min_months": 48, "age_max_months": 155, "dose_text": "One spray into each nostril once daily" } ], "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": "chronic-rhinosinusitis" }, { "id": 458, "generic": "Sodium chloride 0.9%", "line": 1, "is_adjunct": true, "form": "spray", "strength_mg": null, "adult_dose": "Nasal saline irrigation or spray, each nostril, once or twice daily. Use BEFORE the steroid spray so it is not washed straight out.", "adult_duration": "long-term", "dose_source": "Chronic Sinusitis - StatPearls, updated 12 January 2026 - https://www.ncbi.nlm.nih.gov/books/NBK441934/", "rationale": "EPOS 2020 advises nasal saline irrigation for adult chronic rhinosinusitis. Its finding is that rinsing with isotonic saline, or with Ringer's lactate, works in these patients, and that the evidence is too thin to establish a large volume as better than a nasal spray. StatPearls pairs the rinse with the steroid, as the two things most people gain from using steadily. Neither document gives a frequency, so the once-or-twice-daily figure and the saline-before-steroid order are flagged in the cautions below as practice convention rather than sourced guidance - the card must not read as though either document said them.", "cautions": [ "Order matters: saline first, then the steroid.", "Isotonic saline or Ringer's lactate, not hypertonic. EPOS 2020 backs nasal saline irrigation using isotonic saline or Ringer's lactate, while advising against baby shampoo and against hypertonic saline. A spray is not inferior to high-volume irrigation on the evidence EPOS reviewed.", "Irrigation must use boiled-and-cooled or distilled water, never untreated tap water.", "This relieves symptoms; it does not treat the underlying mucosal disease on its own.", "The once-or-twice-daily frequency and the saline-before-steroid order are common practice, not statements taken from either document cited here. EPOS 2020 gives no frequency for saline and no sequence relative to the steroid; StatPearls gives neither either. Both are reasonable and neither is unsafe - they are simply not sourced, and are marked so rather than dressed as guidance." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Safe in children and often the only thing they will tolerate. Use an age-appropriate device.", "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": "RHINO-MARINE PEDIATRIC NASAL SPRAY 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEKEM", "price_egp": 32.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FREE NOSE NASAL SPRAY 30 ML (0-6 YEARS)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARMALINK S.L. > AUG PHARMA", "price_egp": 75.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FREE NOSE NASAL SPRAY 30 ML (6+ YEARS)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARMALINK S.L. > AUG PHARMA", "price_egp": 75.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SOFIMER 0.9% MINI ISOTONIC NASAL SPRAY 30 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "> SOFICOPHARM", "price_egp": 170.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PHYSIOMER NORMAL JET NASAL SPRAY 135ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "LABORATOIRE DE LA MER > STAR INTERNATIONAL COMPANY", "price_egp": 300.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EAU DE MER ISOTONIC NASAL SPRAY 30% 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "> SANDOZ", "price_egp": 350.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MARIMER ISOTONIC NASAL SPRAY 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "LABORATOIRES GILBERT - FRANCE > UNITED BIONAT", "price_egp": 385.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PHYSIOMER BABY MIST NASAL SPRAY 115ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "LABORATOIRE DE LA MER > STAR INTERNATIONAL COMPANY", "price_egp": 400.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "chronic-rhinosinusitis" } ] }