Context

Acute rhinosinusitis (ARS) is one of the most frequently encountered conditions in primary care; however, its management remains controversial. Until recently, recommendations in ARS have focused principally on differentiating between viral and bacterial aetiologies, with antibiotics routinely recommended for all cases of presumed bacterial origin. However, complications from antibiotics on an individual and societal level have led to concerns regarding this approach. Over the past two decades, several investigators have questioned the need for antibiotic treatment in ARS, performing prospective trials suggesting that antibiotic therapy offers a marginal benefit at best. Physicians nevertheless remain to be convinced, as prescribing behaviour remains out of line with guideline recommendations.1