Don't routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days OR symptoms worsen after initial clinical improvement. (Symptoms must include discolored nasal secretions AND facial or dental tenderness to percussion.)
Most sinusitis in the ambulatory setting is due to a viral infection that will resolve on its own. Despite consistent recommendations to the contrary, antibiotics are prescribed in over 80% of outpatient visits for acute sinusitis.
Sinusitis accounts for 16 million office visits and $5.8 billion in annual health care.
Sources: Center for Disease Control and Prevention (CDC), Cochrane, and Annals of Internal Medicine
Sinusitis is one of the most common diagnoses in primary care. Annually, it accounts for 15% to 20% of adult antibiotic prescriptions and costs more than $20 million in patient visits. Current recommendations strongly support not prescribing antibiotics within the first week of illness for mild to moderate sinusitis.(1) A meta-analysis published in 2012 in the Archives of Internal Medicine states that some randomized controlled trials showed that patients assigned to antibiotics had a 7% to 14% higher rate of improvement in symptoms.(2) However, these researchers concluded that the potential harms from use of antibiotics to manage sinusitis, including adverse effects (e.g., diarrhea), increased risk of antibiotic resistance, and cost, clearly outweigh the potential minor benefits.
For Your Patients
A Cochrane review compiled data from 59 studies that involved the use of a variety of antibiotics to manage simple maxillary sinus infection in primary care settings.(3) Studies that compared antibiotics with placebo showed that, in most cases, symptoms improved within two weeks, regardless of whether the participant received an antibiotic or not. The review found that, in addition to patient-related adverse effects (e.g., skin rash, abdominal pain, vomiting), antibiotic use poses the risk of increased resistance to antibiotics among community-acquired pathogens.
Watch the video as Dr. LeFevre talks with a patient who asks for antibiotics to treat her sinusitis.
This recommendation is provided solely for informational purposes and is not intended as a substitute for consultation with a medical professional. Patients with any specific questions about this recommendation or their individual situation should consult their physician.
The Choosing Wisely®(www.choosingwisely.org) campaign was created as an initiative of the American Board of Internal Medicine (ABIM) Foundation(www.abimfoundation.org) to improve health care quality. More than 50 specialty societies have identified commonly used tests or procedures within their specialties that are possibly overused.
Learn more about the AAFP support of the Choosing Wisely® campaign.
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Antibiotics for Sinusitis