HFHT's Choosing Wisely Newsletter
For the whole healthcare team.
Issue 64: Sinusiti s
As we head into another season of viruses, it is important to remember good antibiotics stewardship. Mathematical modelling has shown that by the year 2050, if we continue as we are now, more people will die world-wide from antibiotic-resistant infections than cancer.
This will be the first in a series of scenarios taken from Choosing Wisely Canada and their Using Antibiotics Wisely campaign.
A 52-year-old man with an 8-day history
  • Nasal obstruction
  • Frontal headache
  • Productive cough with green phlegm each morning

Patient does not appear very sick but is clearly bothered by his symptoms.

Does he need antibiotics?

Uncomplicated Sinusitis:

Most cases are viral. You should consider antibiotics ONLY in the following:

  1. Symptoms have been present for at least 7 days AND
  2. There are at least 2 of the PODS symptoms AND
  3. One of the symptoms is O or D AND
  4. The symptoms are severe OR they are still present after a 3 day trial of nasal corticosteroids.

P - facial P ain, pressure or fullness
O - Nasal O bstruction
D - Nasal purulence or discoloured postnasal D rainage
S - Hyposmia or anosmia ( S mell)
What to do with our case?

He fits all the criteria except severity.

Recommended management:  

Nasal steroids and antibiotics only if he doesn’t respond.

Option 1:  nasal steroids and a VIRAL PRESCRIPTION and follow-up if necessary.
Option 2:  nasal steroids and a DELAYED PRESCRIPTION .

This content was provided by the Antibiotics Wisely campaign of choosingwiselycanada.org

The Delayed Prescription and the Viral Prescription are downloadable in custom format for Telus, Oscar and Accuro directly from Choosing Wisely Canada .  
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