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GPs told to avoid prescribing antibiotics for acute sinusitis

GPs should not prescribe antibiotics as first-line treatment for sinusitis, and instead advise patients to rest and relieve symptoms with paracetamol, NICE has said.

NICE said the final guideline, published today, comes as data showed antibiotics were given to 91% of patients visiting their GP with symptoms of sinusitis.

But according to the guidance, only about 2% of cases of acute sinusitis are 'complicated by bacterial infection' and most patients will recover in 2-3 weeks 'without treatment' regardless of whether the infection is caused by a virus or bacteria.

The guideline, developed with Public Health England, adds that 'complications of acute sinusitis are rare (about 2.5 to 4.3 per million people per year)' and that 'withholding antibiotics is unlikely to lead to complications'.

For patients with symptoms for 10 days or less, the guideline says GPs should 'not offer an antibiotic prescription' and give advice about 'the usual course of sinusitis', 'an antibiotic not being needed', managing symptoms with self care and seeking medical help if symptoms 'worsen rapidly or significantly'.

For patients with symptoms for more than 10 days, GPs are advised to 'consider prescribing a high-dose nasal corticosteroid for 14 days for adults and children aged 12 years and over', but still consider 'no antibiotic prescription' or a 'back-up antibiotic prescription'.

An immediate antibiotic prescription should be offered to patients 'presenting at any time who are systemically very unwell, have symptoms and signs of a more serious illness or condition, or are at high risk of complications'.

They should be referred to hospital if their acute sinusitis symptoms are associated with a severe systemic infection; intraorbital or periorbital complications; or intracranial complications.

Professor Gillian Leng, deputy chief executive at NICE said: 'Antibiotic resistance is one of the greatest dangers to our health, which is why we must all work together to fight it.

'Our new guidance will help healthcare professionals to use antibiotics efficiently and only when they are really needed. This will help to protect these vital medicines and ensure that no one experiences side-effects from a treatment they do not need.'

Dr Tessa Lewis, GP and chair of the managing common infections guidance committee, said: 'We know that most people with sinus infections will recover in a couple of weeks without needing any antibiotics, but that doesn’t mean we should be sending them home without any information or advice.

'Health professionals can help their patients cope with this infection and the sometimes unpleasant symptoms it can cause. They should tell them that they’ll probably be feeling this way for a while, and that unless they are very unwell, the best thing to do is to take paracetamol and take it easy.'

Click here to read the full guideline

Readers' comments (9)

  • What is needed to implement this guidance is total guaranteed immunity from any medico-legal fall-out should a member of the 2% who DID need an antibiotic become seriously ill/suffer permanent damage/die. But as usual GPs will be left exposed at both ends as either abusing antibiotics or ignoring sepsis.
    And many patients rightly or wrongly tell us antibiotics are the only treatment that works. If Dr A refuses, they will try Dr B, then Dr C in A&E. At the time of tipping point in both primary and secondary care, is this really wise? Surely deferred prescriptions, involving only one GP contact, is the way forward.

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  • Complicated by bacterial infection does not mean "needs antibiotics".
    I like this guidance.

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  • Don't tell us, tell our patients.
    Properly help us to manage their expectations. Give us longer appointments to explain this to them - bear in mind we only have 4 clinical minutes in every 10 minute appointment, and the patient will on average have brought 3-4 issues.
    Then pay us for the 48-72 hourly phone-calls and/or follow up appointments that they insist on having in order to complain that they are still not better, are missing work or school
    - and to try to convince us that they are in the 2% that need antibiotics.
    Then cover us for the unhappy, dissatisfied patients who complain that our failure to issue antibiotics has caused them to fail their exam/get sacked etc etc.

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  • This guidance will not work in the current toxic environment you Ivory towered imbeciles.

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  • AlanAlmond

    Maybe we need guidance on the management of dissatisfied unhappy patients who re-present on multiple occasions booking serial emergency appointments for the same viral illness...until some bozzo finds a reason to prescribe the antibiotic they want.
    I wonder if the burden of repeated unnecessary appointments resulting from patient ‘dissatisfaction’ has been factored into this guidance. I can guarantee it hasn’t

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  • We all know this. Direct your energies to finding ways of convincing the public. That will help.
    That tiny outlier on your research graph that shows the rare complication can mean the end of a patients life and a docs career. Research that.

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  • I'm sorry but the advice given is at odds with my clinical experience over a long career striving at the coal face of general practice..but what to I know!
    No doubt,once the fallout of following this advice becomes clear and both a significant number of patients (and doctor's careers) come to harm & ENT clinics are busier with chronic sinusitis and it's sometimes serious complications as a result, there will be a further announcement of "as you were". I am completely behind the advice about appropriate prescribing but when bacterial infections complicate (what albeit may have been an original viral infection) antibiotics are an effective treatment in my humble experience.

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  • sigh, I totally agree in some respects and disagree in others. Some patients clearly do benefit from antibiotics - I'm one of them. When I get bacterial sinusitis, as opposed to a bunged up nose, antibiotics shorten my duration of illness from 14 days to 2, and thats an extra 12 days where I'm not dragging myself around drugged up trying not to make mistakes at work...or cancelling clinics.

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  • Only 2% are complicated by bacteria infections. At 1% operation risk, we need to inform them and 2% is acceptable? I wonder if the person that wrote the guidance actually sees patients. I pray his/her patients do not get brain abscess/complications.

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