New guidelines: Don't treat most sinus infections with antibiotics

The majority (90% to 98%) of sinus infections is caused by viruses and should not be treated with antibiotics, according to new guidelines from the Infectious Diseases Society of America.

Sinus infections are the fifth leading indication for antibiotic prescriptions, making antibiotic overprescription a major concern due to the difficulty in differentiating bacterial infections from viral infections, according to the 11-member panel chaired by Anthony W. Chow, MD, professor emeritus of infectious diseases at the University of British Columbia, Vancouver, Canada.  

“A recent national survey of antibiotic prescriptions for URI (upper respiratory infections) in the outpatient setting showed that antibiotics were prescribed for 81% of adults with acute rhinosinusitis, despite the fact that approximately 70% of patients improve spontaneously in placebo-controlled randomized clinical trials,” stated the panel, which included experts from the U.S. Centers for Disease Control and Prevention, the American College of Physicians, and the Society of Academic Medicine.

The new guidelines are based on a Grading of Recommendations Assessment, Development and Evaluation (GRADE) system that includes the systematic weighting of the strength of recommendation and quality of evidence.  These guidelines aim to improve the appropriate use of antibiotics for patients diagnosed with bacterial sinus infections and to reduce overprescription in patients with viral sinus infections to prevent antibiotic resistance.

The new guidelines recommend:

Clinical presentations for differentiating between patients with bacterial infections and those with viral infections.

Antibiotic therapy should be initiated as soon as the clinical diagnosis of a bacterial sinus infection is made.

Adding clavulanate to amoxicillin in the treatment of bacterial sinus infections to overcome antibiotic resistance.

Clinicians refrain from using other commonly used antibiotics, including azithromycin, clarithromycin, and trimethoprim-sulfamethoxazole, because of increasing drug resistance.

Additional recommendations offer guidance for length of therapy as well as managing patients whose diseases don’t respond to initial therapy and those with a history of penicillin allergy.