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.4 However, 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?4 Our 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.