Acute sinusitis and sore throat in primary care – what evidence?
An excellent paper by Professor Chris Del Mar in Australian Prescriber unpacks the Cochrane reviews on the (quite minimal) value of antimicrobial treatment of these conditions. The evidence level is quite robust. For a summary, see below.
It couples nicely with a recent pragmatic randomized controlled trial that examined the effectiveness of steam inhalation and nasal irrigation for chronic or recurrent sinus symptoms in primary care, published in the CMAJ. This showed moderate significant long-term efficacy for nasal irrigation. Steam inhalations were NOT effective.
SUMMARY (Australian Prescriber, 2016)
Sore throat and acute sinusitis are not straightforward diagnoses. Trying to guess the responsible pathogen may not be the best approach.Being guided by empirical evidence may be more useful. It suggests some, but very few, benefits for antibiotics. This has to be balanced with some, but few, harms from antibiotics, including diarrhoea, rash and thrush.
Prescribers should also be aware of the risk of antibiotic resistance for the individual, as well as for the population as a whole.GPs should explain the evidence for the benefits and the harms of antibiotics to patients within a shared decision-making framework.
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