Saline Nasal Irrigation For acute Sinusitis (II): A Randomized Controlled Pilot Trial

Acute sinusitis is one of the commonest infections managed in primary care. Currently GPs prescribe antibiotics to more than 90% of patients with sinusitis.The trouble with antibiotics is that bacteria are becoming resistant. This is likely to lead to serious infections becoming untreatable from ‘superbugs’. Alternatives to routinely using antibiotics straight away are needed.Saline nasal irrigation involves rinsing the sinuses through the nose with saline (salt) solution. There have been no good studies of saline irrigation in acute sinusitis.

Previous studies have used this for colds but the studies are small. A large study in people with chronic sinusitis showed that most people can do nasal irrigation with simple advice, find it acceptable and will keep doing it over weeks. However, nasal irrigation could be made even more effective by dealing with key problems some people have. The first part of the proposed study will interview patients to make sure we are providing the advice and materials people need. We will then ask more than 100 people with acute sinusitis to get either a) immediate antibiotics (current usual treatment) or b) to use 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). We will see from a daily diary how bad symptoms are, and whether antibiotic were used. Participants who are happy to have tests will have a swab of the nose.

This study will provide information about how easy it is to recruit people and follow them up. It will also provide a reasonably good indication about whether antibiotic use can be cut down. This should be enough information to allow us to make a larger application for a full trial.