Antibiotics for acute purulent rhinitis

Probably effective but not routinely recommended

Despite efforts to lower the prescribing of antibiotics for upper respiratory infections the prescription rates are still over 60%.1 Mucopurulent rhinitis is a component of the common cold, for which antibiotics are generally not effective.2 Guidelines specifically recommend against using antibiotics to treat rhinitis. 3 4 Nevertheless, the colour of the nasal discharge doubles the odds of being prescribed antibiotics.5 In one study no general practitioners said that they would give antibiotics for clear rhinitis but 72% would for purulent rhinitis.6 Moreover, a recent study of acute purulent rhinitis showed a significant reduction in the duration of purulent symptoms from 14 days for placebo to nine days for amoxicillin.7 These findings warrant a reconsideration of the evidence and guidelines for antibiotics in acute purulent rhinitis.

One evidence based guideline in paediatrics (reviewed by the American Academy of Pediatrics) stated that mucopurulent rhinitis is not an indication for antimicrobial treatment unless it persists for more than 10 to 14 days.3 Although this may be sensible advice, it is referenced to only one study, by Todd et al, who found no benefit from cephalexin for mucopurulent nasopharyngitis at five to six days.8 In contrast to the text, the table in that guideline includes two other papers that actually found a benefit for antibiotics on …