Antibiotic resistance is a major and growing problem. The use of antibiotics increases the risk of resistance. It is therefore important to keep the antibiotic use low and not to use antibiotics unnecessarily.
The respiratory tract infection most often treated with antibiotic tablets in general practice is sinusitis. This disease alone accounts for about 10% of the antibiotic use in general practice, although antibiotics do not work very well against the disease. Norwegian researchers have previously found that a treatment other than antibiotic tablets, namely antibiotic eye drops, works better against sinusitis. This study was small and therefore cannot provide reliable answers. In this project, we will perform a large trial that can provide reliable answers to whether antibiotic eye drops are a good treatment option for sinusitis in general practice. Antibiotic eye drops cause less resistance than antibiotic tablets. If the new treatment option proves to be safe and effective, this project can lead to a significant decrease in the use of antibiotics in general practice.
The project includes an interview study among patients and general practitioners about sinusitis. This will give us an understanding of why so much antibiotics are used against sinusitis, and it will provide the knowledge needed to optimize the trial.
We will also retrieve information about sinusitis from many of the large and reliable health registers in Norway. This will show whether it is safe to decrease the antibiotic use against sinusitis in Norwegian general practice. It is very rare that sinusitis causes serious complications, but we need to be sure that a reduced antibiotic use in general practice does not lead to an increase in hospital admissions for sinusitis.
The Covid-19 pandemic led to some parts of the project being postponed. The interview study among GPs is now complete, and the results are analysed. The first paper from the registry study has been approved and will be published soon. The first patients in the eye drop study were included in April 2022.
The suffering due to antimicrobial resistance is increasing worldwide. The occurrence of resistance is closely connected to the use of antibiotics, hence it is vital to avoid unnecessary antibiotics use. Acute sinusitis is the single diagnosis for which the largest volume of antibiotics is prescribed – about 10% of all antibiotics in primary care, although the clinical effect is nonexistent for most patients. There is a large discrepancy between knowledge on effect and real life practice. Serious complications due to acute sinusitis are very rare, but a subgroup of patients may need antibiotics in order to avoid complications. A new treatment for acute sinusitis; chloramphenicol eye drops normally used for eye infections, has shown better effect than antibiotics for sinusitis symptoms in a small study. The eyedrops enter the nasal cavity through the tear duct, and may have a local effect on the sinusitis symptoms. A large study is necessary to confirm these findings.
In our proposed study we will
• explore the reasons behind the unnecessary antibiotics use for acute sinusitis in primary care, through interviews and surveys
• analyze the risk of compliactions due to non-antibiotic treatment of acute sinusitis, through health registry research
• test the effect of chloramphenicol eye drops for acute sinusitis, through a trial in primary care
For other self-limited infections like otitis and bronchitis, there has been a shift away from unnecessary antibiotics use. This study may initiate a corresponding shift for acute sinusitis.
The study is large and complex. The main challenges will be patient recruitment, approvals to extract and combine data, and information flow between sub-studies. In order to overcome these challenges, we will
• use a new research network in primary care, which greatly simplifies patient recruitment
• involve researchers with expertice in handling and approving for large data sets
• establish procedures for close cooperation and communication