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NOSE SYMPTOMSRunny or blocked noseAsk about duration and associated symptoms.Bleeding noseSore throatand/or feverCommon cold likelyBody aches/musclepains and/or feverand/or cold chillsInfluenza (flu) likely• Advise the patient with influenza:--bed rest--avoid contact with others to prevent spread--use tissues when sneezing/coughing anddispose of these carefully.• Pain and fever relief (paracetamol 1g 6 hourly)• Regular oral fluids• Reassure patient that antibiotics are notnecessary. Use antibiotics only if pus onexamination.• Colds and flu should improve within 3–7 days.Purulent nasal and/or post nasal dischargeand/or headache worse on bendingforward and/or pressure over sinusesSinusitis likely• Give paracetamol 1g 6 hourly• If pus from nose or symptoms > 6days: give amoxicillin 500mg8 hourly for 5 days. If penicillinallergic, erythromycin 500mg6 hourly for 5 days instead.• Salt water washes or steaminhalation may relieve symptoms.• Refer if:--Associated tooth infection--Poor response to treatment--Swelling over a sinus or aroundeye--Meningism• If sinusitis is recurrent and statusunknown, test for HIV 60.• Recurrent sinusitis is a stage 2 HIVdiagnosis. Patient needs routine HIVcare 61.Recurrent episodes of sneezing anditchy nose most days for > 4 weeksAllergic rhinitis likely• Chlorpheniramine 4mg 6–8hourly for up to 5 days only whensymptoms worsen (side effect issedation).• Refer if no improvement withabove treatment and symptomsdebilitating.• If persistant (≥ 4 days per week),give beclomethasone nasal spraylong term 2 sprays in each nostrildaily and cetirizine 10mg at night.• Pinch nose wings together for 10minutes.• Check BP.--If < 90/60, elevate legs and give IVsodium chloride 0.9%.--If ≥ 130/80 73.• If still bleeding:--Insert nasal tampons or BIPPstripping into bleeding nostril/s.--Refer for further management ifbleeding persists.• If patient has recurrent episodes:--Advise patient to avoid nosepicking,contact sport and traumato nose.--Educate patient to pinch the softnose wings when bleeding.13