NHG Guideline on Acute Rhinosinusitis

The Guideline on Acute Rhinosinusitis published by the Dutch College of General Practitioners (NHG) provides guidelines for the diagnostic workup and treatment of acute rhinosinusitis. It rightly devotes much attention to the limited indications for prescribing antibiotics, as antibiotics appear to offer no added value in terms of recovery or the prevention of complications, whereas they regularly cause side-effects. Furthermore, a restrictive antibiotics policy is to be recommended in view of the growing problems of bacterial resistance (Gebu 2012; 46: 73-79). On the basis of theoretical assumptions, the guideline development team has concluded that antibiotics may be useful in the treatment of specific patient groups. Unfortunately, it is precisely these groups which are excluded from trials into the effects of antibiotics, hampering the evidence in this guideline. This problem has been commented on before (Gebu 2008; 42: 68).
The guideline no longer recommends azitromycin, in view of the resistance issues. What the guideline does not explicitly mention is that this drug is also associated with an elevated, and hence avoidable, risk of cardiovascular disorders and mortality. In view of the many and serious side-effects of NSAIDs, prescribing them for relatively innocuous disorders like sinusitis should be done only in consultation with the patient. 


  • mw drs Z. Damen-van Beek