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Which Antibiotic (Or None) for Sinusitis?

Overuse of expensive, second-line antibiotics in respiratory infections has been documented in previous studies. In this study, a pharmaceutical database was used to assess antibiotic use in 29,102 adults with acute sinusitis: It provided information on clinical diagnosis, antibiotic use, whether a second antibiotic was prescribed, significant complications, and direct antibiotic charges.

Seventeen different antibiotics were prescribed for patients with sinusitis, of which 59.5 percent were considered first-line (i.e., amoxicillin, trimethoprim-sulfamethoxazole, erythromycin); all others were considered second-line. Most antibiotics were prescribed by primary care physicians, who used first-line antibiotics in 60.3 percent of cases, compared with 36.5 percent for specialists. The success rate, as measured by lack of a second antibiotic prescription, was 90.1 percent for the group who received first-line antibiotics and 90.8 percent for the group who received second-line antibiotics, a difference that is statistically, but not clinically, significant. An extremely low rate of complications was noted: 1 case of periorbital cellulitis in each group. The cost of second-line antibiotics averaged roughly twice that of first-line antibiotics ($135 vs. $66).

Comment: These researchers found no incremental clinical benefit associated with the use of expensive second-line antibiotics. In addition, a recent clinical guideline recommends conservative therapy for at least 7 days before antibiotics are prescribed for patients with mild-to-moderate sinus symptoms (JW Apr 15 2001, p. 68, accession number 010327001; and Ann Intern Med 2001 134:495, 498), so many of these patients probably did not require antibiotics at all.

— TL Schwenk

Published in Journal Watch General Medicine November 2, 2001

Citation(s):

Piccirillo JF et al. Impact of first-line vs second-line antibiotics for the treatment of acute uncomplicated sinusitis. JAMA 2001 Oct 17 286 1849-1856.

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