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BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering

Better treatment for Acute Sinusitis In primary health Care - BASIC

Alternative title: Bedre behandling av akutt sinusitt i allmennpraksis

Awarded: NOK 15.0 mill.

Project Number:

288165

Application Type:

Project Period:

2019 - 2025

Location:

Antibiotic resistance is a major and growing problem. The use of antibiotics increases the risk of resistance occurring. It is therefore important to keep the use of antibiotics low, and not to use antibiotics unnecessarily. The respiratory infection most often treated with antibiotic tablets in general practice is sinusitis. At the start of the research project, the disease alone accounted for around 10% of antibiotic use in general practice, even though antibiotics do not work very well against the disease. In a previous study, Norwegian researchers found that a treatment other than antibiotic tablets, namely antibiotic eye drops, may work better against sinusitis. This study was small and therefore cannot provide certain answers. In this project, we will conduct a large trial that can provide reliable answers as to whether antibiotic eye drops are a good treatment for sinusitis in general practice. Antibiotic eye drops cause far less resistance than antibiotic tablets. If the new method of treatment proves to be safe and effective, the project could lead to a significant decrease in the use of antibiotics in general practice. In the project, we will also conduct an interview survey of patients and doctors about sinusitis. This will give us an understanding of why so many antibiotics are used against sinusitis, and it will provide the knowledge necessary to adapt the trial as best as possible. We will also obtain information about sinusitis from many of the large and reliable health registers in Norway. This will show whether it is safe to reduce the use of antibiotics against sinusitis in Norwegian general practice. It is very rare that sinusitis becomes serious and dangerous, but we must be sure that a reduced use of antibiotics 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 of GPs and patients is now complete, and an article has been published. The first two articles from the registry study have also been published. 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

Funding scheme:

BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering