Management of acute maxillary sinusitis in Finnish primary care. Results from the nationwide MIKSTRA study.
OBJECTIVE
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).


METHODS
A cross-sectional multi-centre epidemiological survey.


METHODS
Thirty primary care health centres in Finland.


METHODS
7284 patients with symptoms of possible acute rhinosinusitis during one week in both November 1998 and November 1999.


METHODS
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.
Varonen
Helena
H
Finnish Medical Society Duodecim, Helsinki, Finland. helena.varonen@duodecim.fi
Rautakorpi
Ulla-Maija
UM
Huikko
Solja
S
Honkanen
Pekka O
PO
Klaukka
Timo
T
Laippala
Pekka
P
Palva
Erkki
E
Roine
Risto
R
Sarkkinen
Hannu
H
Mäkelä
Marjukka
M
Huovinen
Pentti
P
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015523:Maxillary Sinusitis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy
D000900:Anti-Bacterial Agents