Choosing Wisely:

Don’t routinely prescribe antibiotics for acute, mild to moderate sinusitis unless symptoms (which must include purulent nasal secretions and maxillary pain or facial or dental tenderness to percussion) last at least seven days or symptoms worsen after initial clinical improvement.

Rationale and Comments: Most cases of maxillary sinusitis in the ambulatory setting are caused by a viral infection that will resolve on its own. Despite consistent recommendations to the contrary, antibiotics are prescribed in more than 80% of outpatient visits for acute sinusitis. Sinusitis accounts for 16 million office visits and $5.8 billion in annual health care costs.
Sponsoring Organizations:
  • American Academy of Otolaryngology–Head and Neck Surgery Foundation
  • American Academy of Family Physicians
  • American Academy of Allergy, Asthma and Immunology
  • Sources:
  • Cochrane Database of Systematic Reviews
  • Annals of Internal Medicine
  • Disciplines:
  • Infectious disease
  • Otolaryngologic
  • References: • Centers for Disease Control and Prevention
    • Annals of Internal Medicine
    • Ahovuo-Saloranta A, et al. Antibiotics for acute maxillary sinusitis. Cochrane Database Syst Rev. 2008;(2):CD000243.

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