Management of acute maxillary sinusitis in Finnish primary care -: Results from the nationwide MIKSTRA study

Objectives - To study the management of acute maxillary sinusitis (AMS) in Finnish primary care and to compare it both to recommendations in national guidelines and to the management of other upper respiratory tract infections (URTI). Design - A cross-sectional multi-centre epidemiological survey. Setting - Thirty primary care health centres in Finland. Subjects - 7284 patients with symptoms of possible acute rhinosinusitis during one week in both November 1998 and November 1999. Main outcome measure - Symptoms and their duration, use of diagnostic tools, choice of antibiotics, patient outcomes. Results - A total of 1601 patients were diagnosed as having AMS (12% of all patients with infectious disease). In 45% of cases the differentiation between AMS and URTI was based on clinical examination alone. Sinus ultrasound was the most common diagnostic tool used (38%). Sinus radiography or blood tests (CRP or leukocytes) were both studied in 8% of cases. AMS was diagnosed and treated with antibiotics also in the early stages of URTI when viruses are the most likely explanation. In total, 83% of patients with AMS received a prescription for antibiotics; the most common choice was amoxycillin (37%), doxycycline was used in 29% of cases, and macrolides in 15%. Conclusions - Antibiotics are prescribed for AMS 2 to 5 times more often than true disease incidence would suggest in Finland. The choice of antibiotics follows the guideline recommendations; however, use of macrolides is higher than recommended. Physicians feel strong pressure from patients to prescribe antibiotics for AMS. Primary care physicians need better support in the accurate diagnosis of AMS.