It’s an intake shift and yet another person comes in saying, “I feel congested doc. I need antibiotics for sinusitis.”
A recent Cochrane review published in September 2018 that included 15 trials involving 3057 patients reviewed the need for antibiotics in acute rhinosinusitis (infection of the nasal passages and paranasal sinuses of less than 4 weeks). The results found that without antibiotics, 46% got better within 1 week and 64% within 2 weeks. Although they can shorten time to cure, it only did so in 5-11 per 100 people compared to placebo. A number of people also experienced side effects from antibiotics, like 18 out of 100 experiencing diarrhea (compared with 10 per 100 in a placebo group).
Where does this leave us? The benefit for antibiotics is marginal. Given the lower incidence of serious complications, it is generally not necessary. Now you have some numbers to explain your reasoning to patients who demand antibiotics.
Caveat: This review excludes pediatrics, immunocompromised patients, and those with severe sinusitis.