Acute sinusitis in adults: management by general practitioners

OBJECTIVE: Acute sinusitis is a common condition encountered in general pra ctice and raises the question of appropriate management. Sufficient data ar e still lacking in the literature to provide a fully satisfactory response. METHODS: We conducted a survey among 193 physicians representative of the g eneral practitioners in France to collect 755 cases of acute sinusitis trea ted in the outpatient setting from January 6 through March 15, 1999. We rec orded clinical features and therapeutic management RESULTS: Pain was the predominant clinical sign (97% of the patients). Faci al pain with a highly suggestive localization and aggravated by pressure an d headache were the most frequent. Most of the patients also had a nasal sy mptom (77%) and an infectious context (90%). Three circumstances had been p re-defined by the experts: unique acute sinusitis, acute episode of chronic sinusitis, and recurrent acute sinusitis. In 67% of the cases of unique ac ute sinusitis, the diagnosis of the general practitioner was confirmed a po sterori by the experts. Few complementary tests were ordered (in 17% of the patients) mainly in fragile patients and mainly limited to a radiography o f the sinus (81% of the complementary tests ordered). An oral antibiotic wa s almost always prescribed (96% of the patients) although antibiotics compr ised only 29% of all prescriptions. General corticosteroid therapy (41%), l ocal treatment (73%) and anti-cough or expectoration medications (52%) were also prescribed. Despite the painful nature of sinusitis, analgesics were only prescribed for 36% of the patients. CONCLUSION: This observational survey enabled us to describe the diagnostic and therapeutic strategy used by French general practitioners for acute si nusitis in adults. There was general agreement on the strategy that was wel l adapted to the patient profiles. An evaluation of the different classes o f drugs prescribed, and their efficacy in the outpatient setting, that rema ins to be determined, was not however attempted.