No Benefit From Antibiotics in Acute Sinusitis

Symptoms of acute sinusitis (i.e., localized pain or purulent nasal discharge) are responsible for about 2% of all patient visits to a doctor's office, and antibiotics are prescribed for as many as 98% of these cases (at a cost of about $2.4 billion annually). In most cases, antibiotics are dispensed without performing tests to confirm the presence of sinusitis, and to determine if the responsible organism is treatable with antibiotics. This practice surely leads to excessive use of antibiotics, but how excessive? The answer to this question is suggested by the following observations (in adults).

The symptoms of acute sinusitis resolve within one or two weeks in most patients, regardless of whether antibiotics are used or not (1,2).

The symptoms of acute sinusitis do not resolve more rapidly when antibiotics are given (3).

These observations indicate that most, if not all, of the antibiotic use in patients with suspected acute sinusitis is excessive and unnecessary.

Recommendations
The prevailing opinion is that antibiotics should NOT be used for routine cases of acute sinusitis. Antibiotics should be reserved only for case where there is evidence of systemic sepsis (e.g., fever) (4), or when the symptoms persist for longer than one week and there is radiographic evidence of acute sinusitis (5).

References:
1. Williams JW Jr, Aguilar C, Cornell J, et al. Antibiotics for acute maxillary sinusitis. Cochrane Reviews 2003; 2:CD000243.

2. Ah-See KW, Evans AS. Sinusitis and its management. BMJ 2007; 334:358-361.

3. Williamson IG, Rumsby K, Benge S, et al. Antibiotics and topical nasal steroid for acute maxillary sinusitis. JAMA 2007; 298:2487-2496.

4. Lindbaek M. Acute sinusitis – to treat or not to treat? JAMA 2007; 298:2543-2544.

5. Ah-See KW. Sinusitis (acute). Clin Evid 2005; 13:646-653.