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Antibiotics 'not needed' for most sinus infections, says NICE

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The majority of people with sinus infections will get better without antibiotics and so do not need to be prescribed them according to new official guidance from the National Institute for Health and Care Excellence.

NICE is advising healthcare professionals to tell patients with acute sinusitis that instead of using antibiotics they are in most cases better off resting and manage their aches and pains with paracetamol.

“We know that most people with sinus infections will recover in a couple of weeks without needing any antibiotics”

Dr Tessa Lewis

In addition, the new guideline, developed with Public Health England, states there is no evidence that oral decongestants will help relieve symptoms associated with sinus infections.

Steam inhalation or warm face packs also have no evidence behind them and there is little evidence that nasal decongestants help.

NICE’s new guidance is designed to help limit antibiotic use and reduce antimicrobial resistance.

It follows the launch of a major public awareness campaign by PHE earlier this week aimed at tackling the growing threat of antimicrobial resistance.

In the guideline published today, NICE highlights that acute sinusitis is usually triggered by a viral infection – such as a common cold - and that only around 2% of cases are due to a bacterial infection.

But UK data has shown that currently antibiotics are given to 91% of people who visit their GP with symptoms of sinusitis.

Regardless of whether a virus of bacteria caused the sinus infection, most symptoms will be gone by two to three weeks, without treatment, states the guideline.

Only in cases where a patient has symptoms for around 10 days or more and is showing no signs of improvement should a back-up antibiotic prescription be considered, depending on the likelihood of bacteria being the cause, according to NICE.

Though healthcare professionals should still advise patients that the antibiotics may not be needed immediately and that paracetamol can be used to manage pain, it said.

“Health professionals should tell [patients] that unless they are very unwell, the best thing to do is to take paracetamol and take it easy”

Dr Tessa Lewis

In circumstances where there are signs of a more serious illness, such as double vision or a severe headache, the guidance says these people should be referred to hospital immediately.

For the majority of cases, healthcare professionals should advise patients that sinus infections will clear up without treatment, it stressed.

“We know that most people with sinus infections will recover in a couple of weeks without needing any antibiotics, but that doesn’t mean we should be sending them home without any information or advice,” said Dr Tessa Lewis, GP and chair of NICE’s guidance committee for managing common infections.

“Health professionals can help their patients cope with this infection and the sometimes unpleasant symptoms it can cause. They should tell them that they’ll probably be feeling this way for a while, and that unless they are very unwell, the best thing to do is to take paracetamol and take it easy,” she said.

Professor Gillian Leng, deputy chief executive at NICE, said: “Antibiotic resistance is one of the greatest dangers to our health, which is why we must all work together to fight it.

“Our new guidance will help healthcare professionals to use antibiotics efficiently and only when they are really needed. This will help to protect these vital medicines and ensure that no one experiences side-effects from a treatment they do not need.”

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