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New draft NICE guidance reins in antibiotic prescribing for sinusitis



New draft guidance from NICE suggests antibiotics should not be prescribed for sinusitis lasting less than 10 days.

Acute sinusitis is caused by a virus in 98% of cases and current NICE guidelines suggest antibiotics should only be prescribed for patients who have another illness that puts them at risk of complications or when bacterial sinusitis is suspected – for example if the patient has a fever, severe and unilateral pain or discoloured nasal discharge.

The latest draft guidelines on antimicrobial prescribing for acute sinusitis further clarify when GPs should prescribe antibiotics. The guidelines generally recommend against prescribing antibiotics, stating that they make little difference to symptoms for most people and can cause side-effects including diarrhoea and nausea.

When prescribing an antibiotic, the guidelines recommend penicillin as first choice for both adults and children. They also state that the shortest course likely to be effective should be prescribed, which is a five-day course for both adults and children.

This differs from the existing guidance, which describes amoxicillin as the first-line antibiotic and recommends a seven-day course. The new guidance is also more detailed than the existing, which states only that antibiotics should be prescribed for acute sinusitis in patients ‘who have serious co-morbidities, or other combinations of risk factors’.

Acute sinusitis affects around 15% of people, and UK general practices see around 250 cases of acute sinusitis for every 10,000 person every year.

GPs can send comments on the guidelines to infections@nice.org.uk until 23 June 2017 at 5pm.

Draft guidance in full

For patients with symptoms of 10 days or less:

  • Do not offer an antibiotic.
  • Advise that acute sinusitis usually only lasts 2-3 weeks and an antibiotic is not necessary.
  • Provide guidance on self-care (e.g. use of paracetamol or ibuprofen for pain or fever).

For patients with symptoms of 10 days or more with no improvement:

  • Consider not prescribing an antibiotic or delaying prescription. A prescription can be used if symptoms rapidly deteriorate, significantly worsen or do not improve within a week.
  • Consider offering a high-dose nasal corticosteroid for 2 weeks (for adults and children over 12).

For patients who are very unwell, have symptoms of a more serious illness or are at high-risk of complications:

  • Offer an immediate antibiotic prescription, or further investigation and management based on the NICE guidelines for respiratory tract infections.
  • Refer the patient to hospital if they have symptoms associated with a systemic infection, complications with vision, neurological symptoms such as a severe headache or signs of meningitis.

Source: NICE