ANTIBIOTIC OVERUSE IN RHINOSINUSITIS AND ITS ASSOCIATED RISKS - REVIEW
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5530Keywords:
Rhinosinusitis, Antibiotic Resistance, Antibiotic Overuse, Acute RhinosinusitisAbstract
Rhinosinusitis is a common condition, affecting a large number of patients. In the vast majority of cases, the origin is viral. Results of the studies included in this article indicate that only 0.5-2% of all cases have bacterial etiology. Despite these facts, antibiotics are still widely prescribed for this condition. The aim of this study is to examine antibiotic overuse in rhinosinusitis and potential consequences of this practice.
This review paper was based on resources available in the PubMed database; articles were identified using the following keywords: “rhinosinusitis AND antibiotic resistance”, “rhinosinusitis AND antibiotic overuse” and “acute rhinosinusitis.”. All included articles were published between 2020-2026.
Results indicate that overuse of antibiotics in rhinosinusitis is a common practice in many countries. Increasing antibiotic resistance, along with the spread of multi-drug resistant microbes is one of the major consequences. Recent findings highlight the role of the respiratory microbiota and indicate that antibiotic therapy induces long-term changes in the nasal microbiome. Research shows that there are no significant differences in clinical effectiveness between amoxicillin and amoxicillin-clavulanate.
In conclusion, antibiotic overuse in rhinosinusitis is a prevalent trend and it poses an important problem of public health. Further research is needed to better understand this issue. The implementation of educational programs and development of clear treatment guidelines may help address this problem.
References
Aljeldah, M. M. (2022). Antimicrobial resistance and its spread is a global threat. Antibiotics, 11(8), 1082. https://doi.org/10.3390/antibiotics11081082
Arcimowicz, M. (2024). Rational treatment of acute rhinosinusitis in the context of increasing antibiotic resistance. Otolaryngologia Polska, 78(6), 1–11. https://doi.org/10.5604/01.3001.0054.7506
Bittner, C. B., Plach, M., Steindl, H., Abramov-Sommariva, D., Abels, C., & Kostev, K. (2022). Prevalence of antibiotic prescription in patients with acute rhinosinusitis treated by general practitioners and otolaryngologists in Germany: A retrospective cohort study. Antibiotics, 11(11), 1576. https://doi.org/10.3390/antibiotics11111576
Broderick, D., Biswas, K., Kim, R., & Douglas, R. (2025). Polymicrobial biofilms in chronic rhinosinusitis: A scoping review. Journal of Medical Microbiology, 74(12), 002104. https://doi.org/10.1099/jmm.0.002104
Christensen, T. V., Plejdrup Hansen, M., Jensen, M. S. A., & Hoffmann Merrild, C. (2026). The decision-making process in general practice of when to use antibiotics to treat acute rhinosinusitis. Scandinavian Journal of Primary Health Care, 44(1), 1–14. https://doi.org/10.1080/02813432.2025.2568043
Fokkens, W. J., Lund, V. J., Hopkins, C., Hellings, P. W., Kern, R., Reitsma, S., Toppila-Salmi, S., Bernal-Sprekelsen, M., Mullol, J., Alobid, I., Terezinha Anselmo-Lima, W., Bachert, C., Baroody, F., von Buchwald, C., Cervin, A., Cohen, N., Constantinidis, J., De Gabory, L., Desrosiers, M., . . . Zwetsloot, C. P. (2020). European position paper on rhinosinusitis and nasal polyps 2020. Rhinology, 58(Suppl S29), 1–464. https://doi.org/10.4193/Rhin20.600
Gessner, A., Klimek, L., Kuchar, E., Stelzmueller, I., Fal, A. M., & Kardos, P. (2023). Potential saving of antibiotics for respiratory infections in several European countries: Insights from market research data. Antibiotics, 12(7), 1174. https://doi.org/10.3390/antibiotics12071174
Houtak, G., Bouras, G., Nepal, R., Shaghayegh, G., Cooksley, C., Psaltis, A. J., Wormald, P. J., & Vreugde, S. (2023). The intra-host evolutionary landscape and pathoadaptation of persistent Staphylococcus aureus in chronic rhinosinusitis. Microbial Genomics, 9(11), 001128. https://doi.org/10.1099/mgen.0.001128
Kwon, E., Hathaway, C., & Sutton, A. E. (2025). Acute sinusitis. In StatPearls. StatPearls Publishing.
Michalik, M., Nowakiewicz, A., Trościańczyk, A., Kowalski, C., & Podbielska-Kubera, A. (2021). Multidrug resistant coagulase-negative Staphylococcus spp. isolated from cases of chronic rhinosinusitis in humans: Study from Poland. Acta Microbiologica et Immunologica Hungarica, 69(1), 68–76. https://doi.org/10.1556/030.2021.01580
Okifo, O., Ray, A., & Gudis, D. A. (2022). The microbiology of acute exacerbations in chronic rhinosinusitis: A systematic review. Frontiers in Cellular and Infection Microbiology, 12, 858196. https://doi.org/10.3389/fcimb.2022.858196
Orlandi, R. R., Kingdom, T. T., Smith, T. L., Bleier, B., DeConde, A., Luong, A. U., Poetker, D. M., Soler, Z., Welch, K. C., Wise, S. K., Adappa, N., Alt, J. A., Anselmo-Lima, W. T., Bachert, C., Baroody, F. M., Batra, P. S., Bernal-Sprekelsen, M., Beswick, D., Bhattacharyya, N., . . . Zhou, B. (2021). International consensus statement on allergy and rhinology: Rhinosinusitis 2021. International Forum of Allergy & Rhinology, 11(3), 213–739. https://doi.org/10.1002/alr.22741
Romano, F. R., Anselmo-Lima, W. T., Kosugi, E. M., Sakano, E., Valera, F. C. P., Lessa, M., Roithmann, R., Pignatari, S., Felippu, A. W. D., Meotti, C. D., Barreto, C. C., Solé, D., Goudouris, E. S., Kuschnir, F. C., Pinna, F. R., Serpa, F. S., Matsumoto, G. R. L. L., Freire, G. S. M., Mello, J. F., Jr., . . . Piltcher, O. B. (2025). Rhinosinusitis: Evidence and experience—2024. Brazilian Journal of Otorhinolaryngology, 91(5), 101595. https://doi.org/10.1016/j.bjorl.2025.101595
Rovelsky, S. A., Remington, R. E., Nevers, M., Pontefract, B., Hersh, A. L., Samore, M., & Madaras-Kelly, K. (2021). Comparative effectiveness of amoxicillin versus amoxicillin-clavulanate among adults with acute sinusitis in emergency department and urgent care settings. Journal of the American College of Emergency Physicians Open, 2(3), e12465. https://doi.org/10.1002/emp2.12465
Schwartz, K. L., Langford, B. J., Daneman, N., Chen, B., Brown, K. A., McIsaac, W., Tu, K., Candido, E., Johnstone, J., Leung, V., Hwee, J., Silverman, M., Wu, J. H. C., & Garber, G. (2020). Unnecessary antibiotic prescribing in a Canadian primary care setting: A descriptive analysis using routinely collected electronic medical record data. CMAJ Open, 8(2), E360–E369. https://doi.org/10.9778/cmajo.20190175
Smith, S. S., Caliendo, A., Cheng, B. T., Kern, R. C., Holl, J., Linder, J. A., & Cameron, K. A. (2023). Patient perspectives on the drivers and deterrents of antibiotic treatment of acute rhinosinusitis: A qualitative study. Journal of General Internal Medicine, 38(3), 683–690. https://doi.org/10.1007/s11606-022-07811-y
Torumkuney, D., Nijhara, P., Beltrame, C. O., Baisch, E. Q., & Ferreira, R. M. (2022a). Country data on AMR in Brazil in the context of community-acquired respiratory tract infections: Links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome. Journal of Antimicrobial Chemotherapy, 77(Suppl. 1), i35–i42. https://doi.org/10.1093/jac/dkac215
Torumkuney, D., Poojary, A., Shenoy, B., Nijhara, P., Dalal, K., & Manenzhe, R. (2022b). Country data on AMR in India in the context of community-acquired respiratory tract infections: Links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome. Journal of Antimicrobial Chemotherapy, 77(Suppl. 1), i10–i17. https://doi.org/10.1093/jac/dkac212
World Health Organization. (2025). Global antibiotic resistance surveillance report 2025. https://www.who.int/publications/i/item/9789240116337
Zawadzka-Głos, L. (2023). Microbiota and antibiotic therapy in rhinosinusitis. Otolaryngologia Polska, 77(5), 36–42. https://doi.org/10.5604/01.3001.0053.8709
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Julia Gawlak, Zofia Tarnawska, Karolina Figiel, Emilia Koziara, Mateusz Gawin, Mateusz Gadzina, Aleksandra Golec, Wojciech Sontag, Mateusz Zawisza, Maciej Krzesimir Kuświk

This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.

