Commentary

Sinusitis accounts for 12% of the antibiotics prescribed for adults in primary care.¹ Of additional concern is the trend toward the use of expensive, broad spectrum antibiotics, particularly in an era of emerging antimicrobial resistance.²

The review by Williams et al provides credible evidence that a simple inexpensive antibiotic, penicillin, is effective in achieving a clinical cure for acute sinusitis. More importantly, this evaluation of 32 RCTs found no significant differences in cure rates with extended spectrum antibiotics. One broad spectrum agent, amoxicillin-clavulanate, had higher treatment attrition because of side effects. Interestingly, 1 study referenced by Williams found no benefit for the use of antibiotics in acute sinusitis.

One limitation of this review is the small number of studies that documented radiographic outcomes of sinusitis management plans. Sinusitis relapse rates are also a topic for additional inquiry because only 1 placebo controlled antibiotic trial reported this information. The authors recommend large controlled trials to determine clinical indicators for antibiotic use and clinical outcomes associated with particular antibiotics.

Consumer demand for antibiotics and provider prescribing practices have been implicated in the emergence of antimicrobial resistance.¹ Williams et al's findings, the result of an exhaustive review of published and unpublished sources, should prompt clinicians to revisit the use of penicillin in acute sinusitis. Nurses in primary care have a unique opportunity to reduce the financial and public health costs associated with indiscriminate antibiotic use, firstly by educating patients away from the use of antibiotics in early upper respiratory infection, and, secondly, by reassuring patients that penicillin is an effective first line agent for sinusitis if an antibiotic is warranted.