Treatment of Acute Rhinosinusitis: Discrepancy Between Guideline Recommendations and Clinical Practice

Background: A revised primary care guideline on acute rhinosinusitis (ARS) has been introduced in the Netherlands in 2005, which advocates a more judicious use of antibiotics.

Objective: To investigate whether consultation and prescription rates for ARS in adults changed over recent years in order to provide information on family physicians' behaviour before and after introduction of the revised guideline.

Methods: Retrospective cohort study. All adult patients within the computerized database of Utrecht Primary Care Research Network over the years 2000-09 were included. Clinical diagnoses of ARS were recorded according to the International Classification of Primary Care codes (R75 and/or R09) and drug prescriptions according to the Anatomical Therapeutic Chemical Classification System.

Results: ARS consultation rates revealed a stable pattern, with an average consultation rate of 29 episodes per 1000 person-years. From 2000 to 2005, the antibiotic prescription rate increased from 56 to 62 prescriptions per 100 episodes (P value for time trend <0.05). From 2005 onwards, the antibiotic prescription rate decreased to 56 per 100 episodes in 2009 [rate difference (RD): -6, 95% confidence interval (CI): -10 to -1; P value for difference between 2000-05 and 2005-09 <0.05]. From 2005 to 2009, intranasal corticosteroid (INCS) prescription rate increased from 20 to 31 prescriptions per 100 episodes (RD: 11, 95% CI: 7 to 15; P value for difference between 2000-05 and 2005-09 <0.01). Oral corticosteroid prescription and referral rates remained low.

Conclusions: Despite strong guideline recommendations to restrict the use of antibiotics and INCS, we found only a modest decrease in antibiotic prescription rates, whereas INCS prescription rates even increased.