Prescribing Advice for GPs

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Treatment of Acute Sinusitis

The Journal of the America Medical Association has published the results of a randomised controlled trial that aimed to assess the effectiveness of amoxicillin and topical budesonide in acute maxillary sinusitis.

240 adults with two or more diagnostic criteria (purulent rhinorrhea with unilateral predominance, local pain with unilateral predominance, purulent rhinorrhea bilateral, presence of pus in the nasal cavity) were recruited from primary care setting over a 4 year period. Patients were randomised to one of the following treatment groups:

  • Amoxicillin 500mg three times a day for 7 days and budesonide nasal spray 200micrograms in each nostril once per day for 10 days
  • Amoxicillin 500mg three times a day for 7 days and a placebo nasal spray
  • Placebo antibiotic and budesonide nasal spray 200micrograms in each nostril once per day for 10 days
  • Double placebos

Patients were assessed for clinical cure at day 10 using patient symptom diaries and the duration and severity of symptoms. All three of the active treatments failed to produce a statistically significant increase in the number of patients cured at day 10.

Action: Antibiotics and nasal steroids appear to be ineffective first line treatments for acute sinusitis. Clinicians should ensure they adopt the Clinical Knowledge Summary recommendations to use analgesia and short term intranasal decongestants.

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