Do we need antibiotics in acute rhinosinusitis?

This is a major question to be answered. In the US, one out of every five antibiotic prescriptions is for rhinosinusitis. However, results of studies are inconsistent and clinical benefit with antibiotic treatment is at best small due to the high rate of spontaneous improvement. The vast majority of patients are seen in primary care. The recent study by Garbutt et al (JAMA 2012;307:685-692) is therefore of major interest since it attempts to find the incremental effect of amoxicillin over symptomatic treatment on quality of life in 166 adults clinically diagnosed with acute bacterial rhinosinusitis (7 to 28 days of symptoms). They found that antibiotic treatment was not better than placebo for the control of symptoms after 3 days of treatment whereas some benefit was found after 7 days. Although a true diagnosis of sinusitis was not made, this study reflects primary care practice. Since antibiotic resistance is common, the authors propose "to avoid routine antibiotic treatment for patients with uncomplicated acute rhinosinusitis." What do you think based on your experience?