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Research project

SNIFSII Saline Nasal Irrigation for Acute Sinusitis

Project overview

Acute sinus infections are one of the commonest infections managed in primary care, Currently GPs prescribe antibiotics to most patients presenting with sinusitis, the highest of any of the common acute infections presenting in adults, at over 90%.

The trouble with prescribing for most people is that we are using antibiotics too much which is causing the bacteria to become resistant, which is likely to lead in the future to serious infections becoming untreatable from ‘superbugs’. Alternatives to the initial management with antibiotics are needed.

Previous studies have tried nasal irrigation using salt solution for colds but the studies are small and not conclusive. There have also been studies of nasal irrigation in chronic sinus infections which do show some benefit. A large study in chronic or recurrent sinusitis in primary care showed that most people can learn to do nasal irrigation with simple advice and a short video to show how it is done, find it acceptable and will keep doing it over several weeks. However, there was some evidence that the approach to help people use nasal irrigation could be made more effective, dealing with key barriers or difficulties more effectively. There have been no good studies of saline irrigation in acute sinusitis.

In a separate study, we have worked together with patients to optimise how we help patients use sinus irrigation, making sure that we are providing all the necessary advice and materials to help deal with any issues or problems patients might have. The study will randomise more than 100 people with acute sinus infections presenting in primary care to either a) immediate antibiotics (current usual treatment in primary care) or b) advice to do nasal irrigation for up to 3 weeks with a ‘back-up’ or delayed antibiotic prescription (a prescription that can be used if the sinusitis does not settle). Participants will fill out a daily symptom diary which will allow us to see whether irrigation makes any difference to symptom severity, or to the duration of illness, and whether antibiotic were used.

Participants who are happy to have further tests will have a swab of the nose.

This study will provide evidence of recruitment and follow-up rates, and is also likely to provide preliminary evidence about whether antibiotic use is likely to be reduced, in order to provide sufficient evidence for a larger application for a full trial.

Study team: Ms Tammy E Thomas



Lead researcher

Professor Paul Little

Professor in Primary Care Research
Other researchers

Dr Ben Ainsworth

Associate Professor
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