Acute sinusitis. Who should we be treating?
BACKGROUND: The diagnosis of acute sinusitis has been regarded as a serious condition that requires the use of antibiotics. However the increasing incidence of resistant organisms means antibiotics need to be used carefully. OBJECTIVE: To look at the evidence available regarding antibiotic use for sinusitis, and to discuss its application to general practice. DISCUSSION: There have been surprisingly few randomised double blind placebo controlled trials for sinusitis, and fewer still have been based in a representative population of primary care patients. This article discusses studies relevant to general practice. Several practical clinical symptoms and signs have been shown to increase the likelihood of a patient having acute bacterial sinusitis, and therefore benefit from antibiotics. When antibiotics are used, comparative data suggest that amoxycillin should be used first line. The issue of patient experience, expectations and satisfaction is also raised.