english.prescrire.org > Spotlight > Archives : 2010 > Acute rhinosinusitis in adults: antibiotics should not be prescribed from the outset

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Acute rhinosinusitis in adults: antibiotics should not be prescribed from the outset

In adults presenting a moderate maxillary rhinosinusitis, with no particular risk of infection, complications are rare and there is no need for antibiotic treatment.

What is the role of antibiotics in the treatment of acute rhinosinusitis in adults? Sinusitis is the inflammation of the sinuses (hollow cavities in the skull connecting with the nasal cavities) sometimes of bacterial origin. Diagnosis of sinusitis relies on a series of clinical factors: nasal congestion or discharge, rhinopharyngeal discomfort or discharge in the pharynx, loss of sense of smell, oedema, localised redness, pain around the site of the inflammation, etc. Additional tests are rarely of any benefit.

In patients presenting moderate symptoms with no particular risk of infection and no signs of complication, the infection will generally clear up spontaneously within a week or two. Severe complications are rare, which means there is no need to prescribe antibiotics from the outset. Their efficacy is marginal (only slightly faster cure or improvement than with a placebo), but they expose patients to the risk of adverse effects, severe in a few rare cases. Furthermore, the widespread use of antibiotics leads to bacterial resistance. Treatment of the symptoms is often sufficient.

In patients with a high risk of infection or complications, an antibiotic is warranted. A 5-day course of amoxicillin is the antibiotic of choice.

©Prescrire April 2010

Source: "Rhinosinusites aiguës des adultes" Rev Prescrire 2010; 30 (317): 203-206.