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Background: Antibiotics are overused in patients with acute rhinosinusitis (ARS) as it is difficult to identify those who benefit from antibiotic treatment., Aim: To develop prediction models for computed tomography (CT)-confirmed ARS and culture-confirmed acute bacterial rhinosinusitis (ABRS) in adults presenting to primary care with symptoms suggestive of ARS., Design and Setting: This was a systematic review and individual participant data meta-analysis., Method: CT-confirmed ARS was defined as the presence of fluid level or total opacification in any maxillary sinuses, whereas culture-confirmed ABRS was defined by culture of fluid from antral puncture. Prediction models were derived using logistic regression modelling., Results: Among 426 patients from three studies, 140 patients (32.9%) had CT-confirmed ARS. A model consisting of seven variables: previous diagnosis of ARS, preceding upper respiratory tract infection, anosmia, double sickening, purulent nasal discharge on examination, need for antibiotics as judged by a physician, and C-reactive protein (CRP) showed an optimism-corrected c-statistic of 0.73 (95% confidence interval [CI] = 0.69 to 0.78) and a calibration slope of 0.99 (95% CI = 0.72 to 1.19). Among 225 patients from two studies, 68 patients (30.2%) had culture-confirmed ABRS. A model consisting of three variables: pain in teeth, purulent nasal discharge, and CRP showed an optimism-corrected c-statistic of 0.70 (95% CI = 0.63 to 0.77) and a calibration slope of 1.00 (95% CI = 0.66 to 1.52). Clinical utility analysis showed that both models could be useful to rule out the target condition., Conclusion: Simple prediction models for CT-confirmed ARS and culture-confirmed ABRS can be useful to safely reduce antibiotic use in adults with ARS in high-prescribing countries., (© The Authors.)

Introduction: This protocol outlines a diagnostic individual patient data (IPD) meta-analysis aimed at developing simple prediction models based on readily available signs, symptoms and blood tests to accurately predict acute bacterial rhinosinusitis and CT-confirmed (fluid level or total opacification in any sinus) acute rhinosinusitis (ARS) in adults presenting to primary care with clinically diagnosed ARS, target conditions associated with antibiotic benefit., Methods and Analysis: The systematic searches of PubMed and Embase of a review on the accuracy of signs and symptoms for diagnosing ARS in ambulatory care will be updated to April 2020 to identify relevant studies. Authors of eligible studies will be contacted and invited to provide IPD. Methodological quality of the studies will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Candidate predictor selection will be based on knowledge from existing literature, clinical reasoning and availability. Multivariable logistic regression analyses will be used to develop prediction models aimed at calculating absolute risk estimates. Large unexplained between-study heterogeneity in predictive accuracy of the models will be explored and may lead to either model adjustment or derivation of separate context-specific models. Calibration and discrimination will be evaluated to assess the models' performance. Bootstrap resampling techniques will be used to assess internal validation and to inform on possible adjustment for overfitting. In addition, we aim to perform internal-external cross-validation procedures., Ethics and Dissemination: In this IPD meta-analysis, no identifiable patient data will be used. As such, the Medical Research Involving Humans Subject Act does not apply, and official ethical approval is not required. Findings will be published in international peer-reviewed journals and presented at scientific conferences., Prospero Registration Number: PROSPERO CRD42020175659., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Primary care doctors should be cautious in the diagnosis and treatment of sinusitis as acute bacterial sinusitis is currently over-diagnosed and over-treated in primary care practice. The clinical diagnosis of acute bacterial sinusitis is difficult in primary care practice; however, a history of purulent rhinorrhoea, purulent secretions in the nasal cavity on examination, tooth pain, worsening of symptoms following initial improvement, lack of effect of decongestants and an elevated erythrocyte sedimentation rate are supportive evidence of bacterial infection. Patients with symptoms for <7 days are not as likely to have bacterial infection. Acute sinusitis is over-treated in primary care practice for several reasons. Firstly, most cases of acute sinusitis are caused by viral infections and resolve without antibacterial treatment. Secondly, in clinical trials of antibacterial treatment, only about one-half of patients diagnosed with acute bacterial sinusitis by experienced primary care physicians have bacterial infection. Thirdly, antibacterial treatment of acute sinusitis is indicated only in patients with severe symptoms of sinusitis or in patients with moderate symptoms of >7 days duration. Symptomatic treatment is sufficient in patients with mild symptoms. Three recent meta-analyses have concluded that newer and broad-spectrum antibacterials are not significantly more effective than narrow-spectrum agents, such as amoxicillin or phenoxymethylpenicillin (penicillin V). However, because of the rapid increase in antibacterial resistance of Streptococcus pneumoniae and Haemophilus influenzae, treatment must take into account current recommendations for treating infections caused by these organisms. Fourthly, sinus imaging studies are not recommended in routine diagnosis but may be helpful in selected cases. Finally, other than pain medication, there is little evidence that use of adjunctive treatments, such as decongestants, is effective in symptom relief. However, a recent study in patients with recurrent sinusitis demonstrated that patients who received fluticasone propionate in addition to antibacterials had a higher rate of clinical success than did patients receiving placebo and antibacterials.

Acute sinusitis is a common illness in primary care. Studies have demonstrated the difficulty of making the differential diagnosis of acute purulent sinusitis based on clinical evaluations alone. This leads to a significant overuse of antibiotics, which in turn may contribute to increased bacterial resistance. In most cases, GPs have to base their differential diagnosis of sinusitis on clinical signs and symptoms and examination of the patient. The aim of this review is to assess which clinical signs and symptoms can predict an acute purulent sinusitis, compared with accepted reference standards. A review of the literature was performed by looking at articles related to the diagnoses of acute sinusitis in general practice. The following search criteria were used: unselected general practice population; objective reference standard; and logistic regression to evaluate symptoms and signs independently associated with the diagnosis. Four studies were identified for further analysis. The following symptoms and signs were associated with acute purulent sinusitis: purulent secretion as a symptom experienced by the patient or as a sign demonstrated in the nasal cavity by the doctor; pain in the teeth; pain at bending forward, and two phases in the illness history. An elevated erythrocyte sedimentation rate and increased C-reactive protein also contributed to the diagnosis. By use of the specified signs and symptoms the GP can increase the probability of correctly diagnosing an acute purulent sinusitis and reserve antibiotic prescription for these patients.

Objective - To study results from bacteriological specimens from nasopharynx in patients with a clinical diagnosis of acute sinusitis in relation to CT findings. Design - Prospective study. Setting - Patients from general practice in Vestfold county, Norway. Patients - 427 patients 15 years and older from two studies with a clinical diagnosis of acute sinusitis, and who were examined with coronal CT scans of the paranasal sinuses. Fluid level or total opacification of any sinus was taken as a hallmark of sinusitis. Main outcome measures - Bacteriological findings in nasopharynx specimens and proportions of various sinus pathogens in patients with and without sinusitis confirmed by CT. Results - In the study, 252 patients had acute sinusitis and 175 patients did not. In the sinusitis groups, 27% of the patients had Streptococcus pneumonia, 12% had Staphylococcus aureus and 10% had Haemophilus influenzae in their nasopharynx specimens. Forty five percent of the patients had normal nasal flora or no growth. The strains of Streptococcus pneumonia and Haemophilus influenzae showed high sensitivity to PcV, while the Moraxella strains were resistant to it. Conclusion - Streptococcus pneumoniae and Haemophilus influenzae were the most frequent sinus pathogens found in the nasopharynx specimens, and they were significantly more frequent in the group with confirmed sinusitis. The proportion of specimens with normal nasal flora or no growth was significantly higher in the non-sinusitis group. [ABSTRACT FROM AUTHOR]

Objective - To evaluate which factors present at the onset of acute sinusitis predict the duration of illness among adult patients treated with antibiotics. Design - Cohort study with a 30-day follow-up. Setting - Norwegian general practice. Subjects - Eighty-six adult patients with a clinical diagnosis of acute sinusitis confirmed by Computed Tomography. Methods - Signs, symptoms and other variables present at the onset of treatment were dichotomized and analysed bivariately with duration of the sinusitis episode, using the log-rank test. Age, gender, and factors with p-values under 0.15 were modelled in a Cox regression analysis to assess independent predictors for illness duration. Main outcome measure - Duration of illness. Results - Illness duration was significantly and positively associated with increasing age and with a higher clinical severity score at the onset of treatment. No other factors were independent predictors of illness duration. Conclusion - The age of the patient and the clinical severity of the sinusitis at the onset of treatment were independent predictors of illness duration in adult patients treated with antibiotics. [ABSTRACT FROM AUTHOR]

The article presents information on a study on the effectiveness of mometasone furoate nasal spray, amoxicillin, and placebo, for treating acute rhinosinusitis. Patients 12 years of age with signs and symptoms of acute rhinosinusitis were examined. The methods of the study, intervention, and outcomes are presented.

The article presents information on a research to compare the effects of topical steroids against amoxicillin and placebo for acute rhinosinusitis in primary care. The research was conducted by Meltzer. The research was large with more than 900 patients. The clinical significance of the difference between twice daily mometasone and placebo was unclear.

Focuses on a study of 201 patients with a clinical diagnosis of acute sinusitis which points to the unreliability of clinical symptoms and signs in the diagnosis of sinusitis. Purulent secretion on the nasal floor as the strongest predictor of sinusitis; Other symptoms with high diagnostic accuracy; Symptoms with the lowest degree of diagnostic accuracy.