Acute sinusitis: which factors do FPs believe are most diagnostic and best predict antibiotic efficacy?

Acute sinusitis is almost always a self-limiting condition involving the maxillary sinuses. About half of cases are free of bacterial infection, and 70% to 80% of patients will be symptom-free by 2 weeks, with or without antibiotics.1,2 Only a small proportion develop chronic sinusitis (>12 weeks),3 characterized by low-grade symptoms.4However, unlike other upper respiratory infections, acute sinusitis is still over-treated with antibiotics by primary care physicians—85% to 98% of sinusitis patients in the US receive antibiotic prescriptions,5 92% in the UK,6 80% in Norway,7 and 67% in the Netherlands.8 Why is this so, given the self-limiting nature of sinusitis, the very real threat of increasing antibiotic resistance, and the estimated annual treatment costs of £10 million in the UK and $2.4 billion in the US?4Our study aimed to establish criteria used by family doctors to diagnose acute sinusitis, and to determine the most important factors affecting doctors’ decisions to prescribe antibiotics.