This is a NICE guideline from a couple of months ago in the use of antibiotics in sinusitis. I must say that this has changed my practice significantly, so well worth a read, especially the background information. Main learning points:
- 1st line antibiotic is now penicillin.
- Length of treatment is five days.
- Only consider antibiotics after 10 days of symptoms and even then, most people will not need them.
- A handy patient information leaflet can be found here, explaining why you are not prescribing them antibiotics.
Only 2% of cases are bacterial and complications of sinusitis are rare (only about 4.3 per million per year!). Symptoms generally only last 2-3w, whether it is viral or bacterial and whether you use antibiotics or not.
The NNT (number needed to treat) for antibiotics to improve symptoms in 1 person is 7 – 21. The NNH (number needed to harm) is 8 to 11 and 18 for diarrhoea. Note that antibiotics have little effect on the duration of illness, only on symptom improvement.