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Don’t Routinely Prescribe Antibiotics for Acute Mild-to-Moderate Sinusitis Unless Symptoms Last for Seven or More Days, or Symptoms Worsen After Initial Clinical Improvement

Choosing Wisely Recommendation 2

Choosing Wisely: 2.	Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement.

Country

Australia

Background

Unnecessary antibiotic prescriptions have driven a global increase in antimicrobial resistance. The Australasian Society for Infectious Diseases and the Royal Australian College of General Practitioners, along with other national societies in surgery, pharmacy, pediatrics, and internal medicine, recommend against prescribing antibiotics for sinus, chest, or ear infections.  

The Innovation

Choosing Wisely Australia is an initiative of NPS MedicineWise, who provide evidence-based information and tools to improve appropriateness and quality of prescription medicines in Australia.

These efforts are supported by the Australian government’s national strategy on antimicrobial resistance, released in 2015. A priority of NPS MedicineWise is educating clinicians and the public about antimicrobial resistance and offering resources and tools for prescribers and the public.

 

Choosing Wisely Australia Antibiotic Resistance Infographic
Antibiotic Awareness Week poster

 

Population Targeted

General practitioners. Research conducted in 2012 found that in the three years since the program launched in 2009, almost one-third of Australian general practitioners had participated in an educational activity about unnecessary antibiotic prescribing.

Key Features of the Innovation

NPS MedicineWise’s actions on reducing unnecessary use of antibiotics have included:

  • Mailing educational information to every general practitioner in the country
  • Providing outreach, typically a one-on-one session with a trained clinician educating another physician; this is known as academic detailing
  • Providing clinical audits, which detail practice-specific data on antibiotic prescribing as well as the clinical indications for the antibiotics prescribed.

Robyn Lindner, Ph.D., program manager for Choosing Wisely, says NPS MedicineWise provides physicians with a “symptomatic management pad.” This resource is designed to appear as a prescription pad but instead offers strategies to manage symptoms — for instance, saline spray to relieve congestion. Further, it explains why antibiotics are not helpful for viral infections and the harms of unnecessary antibiotic use, such as diarrhea.

Choosing Wisely Australia Marketing

Choosing Wisely Australia Marketing
Point-of-care decision-making tools to reduce unnecessary antibiotics along with consumer-facing advertising. 

A 2018 study found a 14% total reduction in antibiotics dispensed in Australia since 2009.

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Evidence of Impact

To evaluate impact, Choosing Wisely Australia conducts qualitative and quantitative analyses, including surveying physicians who participate in academic detailing and assessing knowledge. A 2018 article in the Journal of International Medical Research found that 126,536 fewer antibiotic prescriptions per month have been dispensed since the academic detailing program launched in 2009. This is a 14 percent total reduction in antibiotics dispensed in Australia since 2009.

 

Choosing Wisely Australia Respiratory Action Plan

 

Sharing and Spreading the Innovation

Additional patient- and consumer-focused aspects of NPS MedicineWise’s efforts include participating in Antibiotic Awareness Week. For example, in 2016 NPS MedicineWise sponsored a competition of short films in an annual film festival on the topic of antibiotic resistance. This competition, called Save the Script, included 15 finalists and received significant publicity in Australia.

Contact for Further Information

Dr. Robyn Lindner, Client Relations Manager, NPS MedicineWise, [email protected]

This publication is one in our ongoing series on Choosing Wisely

Publication Details

Publication Date: May 9, 2019
Citation:

Karen Born, “Don’t Routinely Prescribe Antibiotics for Acute Mild-to-Moderate Sinusitis Unless Symptoms Last for Seven or More Days, or Symptoms Worsen After Initial Clinical Improvement,” Choosing Wisely (series), Commonwealth Fund, May 16, 2019. https://doi.org/10.26099/fzrq-pb02

Experts

Knowledge Translation Lead, Choosing Wisely Canada
Professor and Past Chair, Department of Medicine at the University of Toronto