Wide variation seen in gluten-free food prescribing

Wide variation seen in gluten-free food prescribing

April 20 2018 Wide variation in gluten-free food (GFF) prescribing does not appear to be driven...

‘Caution in use’ alert issued for Inhixa solution for injection

‘Caution in use’ alert issued for Inhixa solution for injection

April 20 2018 A Class 4 medicines defect alert has been issued relating to Inhixa (enoxaparin...

Views sought on improving health services for people with sensory loss

Views sought on improving health services for people with sensory loss

April 20 2018 Primary care professionals are being asked for views on how to help improve...

Minister: GPs are not precluded from prescribing OTC medicines, but should follow guidance

Minister: GPs are not precluded from prescribing OTC medicines, but should follow guidance

April 20 2018 Doctors have not been prevented from prescribing over-the counter medicines, but...

Epipen manufacturing delays causing stock shortage

Epipen manufacturing delays causing stock shortage

April 17 2018 A manufacturing delay is causing problems around availability of Epipen (Senior)...

  • Wide variation seen in gluten-free food prescribing

    Wide variation seen in gluten-free food prescribing

    Friday, 20 April 2018 16:48
  • ‘Caution in use’ alert issued for Inhixa solution for injection

    ‘Caution in use’ alert issued for Inhixa solution for injection

    Friday, 20 April 2018 16:43
  • Views sought on improving health services for people with sensory loss

    Views sought on improving health services for people with sensory loss

    Friday, 20 April 2018 16:39
  • Minister: GPs are not precluded from prescribing OTC medicines, but should follow guidance

    Minister: GPs are not precluded from prescribing OTC medicines, but should follow guidance

    Friday, 20 April 2018 16:31
  • Epipen manufacturing delays causing stock shortage

    Epipen manufacturing delays causing stock shortage

    Tuesday, 17 April 2018 08:53

a sinusitis imageOctober 30 2017

Patients with acute sinusitis should be advised the condition will normally clear up without antibiotics, NICE has said. In addition, its new guidelines say there is little evidence to support the use of decongestants.

NICE guideline NG79 sets out recommendations on antimicrobial prescribing for acute sinusitis. It notes that “acute sinusitis is usually caused by a virus, lasts for about two to three weeks, and most people get better without antibiotics. Withholding antibiotics rarely leads to complications.”

It estimates only 2% of cases are complicated by a bacterial infection, and that “complications of acute sinusitis are rare,” affecting about 2.5 to 4.3 per million people per year.

The guidelines covers three aspects:

  • managing symptoms, including advice when an antibiotic is not needed and the use of corticosteroids and nasal sprays;
  • choice of antibiotic when a back-up or immediate prescription is needed;
  • self-care.

Recommendation 1.1.1. states: “Do not offer an antibiotic prescription.” Instead, the guidelines say the patients presenting within the first 10 days of symptoms starting should be told about the likely 2-3 week course of the infection, how to manage symptoms and when to seek further advice if the infection is not clearing.

For those presenting with symptoms that have lasted longer than 10 days, and with no signs of improvement, options include to consider nasal corticosteroids, not to consider an antibiotic at that point, or to issue a back-up antibiotic prescription but with very clear advice about self-care and when or if the prescription should be dispensed.

However, the guidance also considers patients “presenting at any time who are systemically very unwell, have symptoms and signs of a more serious illness or condition, or are at high risk of complications.” In such cases, Recommendation 1.1.8 states: “Offer an immediate antibiotic prescription (see the recommendations on choice of antibiotic) or further appropriate investigation and management in line with the NICE guideline on respiratory tract infections (self-limiting): prescribing antibiotics.” NG79 includes a table of antibiotics and prescribing conditions.

It may also be necessary to refer people to hospital, “if they have symptoms and signs of acute sinusitis associated with any of the following:

  • a severe systemic infection (see the NICE guideline on sepsis);
  • intra-orbital or periorbital complications, including periorbital oedema or cellulitis, a displaced eyeball, double vision, ophthalmoplegia, or newly reduced visual acuity;
  • intracranial complications, including swelling over the frontal bone, symptoms or signs of meningitis, severe frontal headache, or focal neurological signs.”

Self-care options include to consider paracetamol or ibuprofen for pain or fever. Health professionals should “explain that some people may wish to try nasal saline or nasal decongestants, although there is not enough evidence to show that they help to relieve nasal congestion.”

In addition, they should “explain that no evidence was found for using oral decongestants, antihistamines, mucolytics, steam inhalation, or warm face packs.”

Links:
NICE announcement     
NICE NG79 ‘Sinusitis (acute): antimicrobial prescribing’

Professional News

April 20 2018 Wide variation in gluten-free food (GFF) prescribing does not appear to be driven by obvious medical factors, a study has suggested. 
April 20 2018 Wide variation in gluten-free food (GFF) prescribing does not appear to be driven by obvious medical factors, a study has suggested.  GFF prescribing is less likely to occur in areas...