Sinusitis (acute): antimicrobial prescribing

Medicines adherence may be a problem for some people with medicines that require frequent dosing (for example, some antibiotics) or longer treatment duration (for example, nasal corticosteroids) (see the NICE guideline on medicines adherence [2009]).

Respiratory tract infections, including acute sinusitis, are a common reason for consultations in primary care, and therefore are a common reason for potential antibiotic prescribing. In a 2011 survey of UK primary care (Gulliford et al. 2014), consultations for sinusitis accounted for 9% of all consultations for respiratory tract infections, but the median practice issued an antibiotic prescription for 91% of these.

There is potential for resource savings if a no antibiotic or a back-up antibiotic prescription is used. One open-label RCT (de la Poza Abad et al. 2015) found there were significantly lower rates of antibiotic collection with back-up (delayed) antibiotic prescriptions (either prescription collection [26%] or patient-led [34.7%]) compared with the immediate prescription group (89.1%, p<0.001; low quality evidence).

Recommended high-dose nasal corticosteroids are available as generic and proprietary products and costs per unit (excluding VAT) range between £1.71 and £12.99 (Drug Tariff, October 2017).

Recommended antibiotics are all available as generic formulations, see Drug Tariff for costs