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February 2015Background
Acute rhinosinusitis is a very common illness that is associated with physical, functional, and emotional impairments and significant treatment costs. Rhinosinusitis is defined as symptomatic inflammation of the sinuses and nasal cavity. Acute rhinosinusitis is classified as illness or symptoms for less than 4 weeks. It is typically a self-limiting disease; however, there are potential rare serious complications of acute infection, including meningitis, orbital infection, and brain abscesses. Due to increasing concerns with antibiotic resistance, and the common confusion of viral rhinosinusitis with bacterial infection, it is important to consider the indications of antibiotic treatment for acute rhinosinusitis. Currently, antibiotics are prescribed very frequently in patients with acute sinusitis; acute rhinosinusitis is the fifth most common condition for which an antibiotic is prescribed in the United States. The management of acute rhinosinusitis in adults has been a controversial topic for many years due to questions about overprescribing of antibiotics as well as inappropriate radiographic imaging and testing.
Best Practice
With the evidence in front of us, we advocate for a change in the prescription habits of primary care physicians providing care to patients with acute rhinosinusitis. In our opinion, with the exception of the very small number of patients with clinical signs of serious complications from acute sinusitis, the published evidence suggests that routine antibiotic treatment in the primary care setting offers little clinical benefit and does have associated adverse effects and leads to the development of antibiotic resistance. However, although antibiotics are not indicated for use in all acute rhinosinusitis patients, acute uncomplicated rhinosinusitis patients are likely a diverse group, and future work may identify clinical factors to suggest patient populations for which antibiotics are indicated. Read the full article in The Laryngoscope.