Over-zealous sinus antibiotic prescribing

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Drug resistance is directly related to the overprescription of antibiotics, say authors.

Antibiotics are prescribed for 70% to 80% of sinus infections even though most are the result of viruses, a study has found.

The use of antibiotics for acute and chronic rhinosinusitis far outweighs the predicted prevalence of bacterial causes of these conditions and boosts the risk of antibiotic resistance, reported Dr Donald Leopold, of the University of Nebraska, and colleagues.The results were published in the Archives of Otolaryngology -- Head and Neck Surgery.

The team used data for 1999 to 2002 from two national surveys (the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey) conducted by the National Center for Health Statistics.

They found that an estimated 14,277,026 visits were made to healthcare facilities for chronic rhinosinusitis (defined as symptoms lasting 12 or more weeks) and 3,116,142 for acute infections (defined as symptoms lasting up to four weeks). In 2002, rhinosinusitis accounted for 21% of all antibiotic prescriptions for adults and 9% for children.

At least one antibiotic was prescribed at 82.74% of visits for an acute infection, and at 69.95% of visits for a chronic infection in which inflammation is actually the most likely cause, the investigators reported.

After antibiotics, the drugs most used were antihistamines, nasal decongestants, corticosteroids, antitussive, expectorant, and mucolytic agents, the authors wrote.

Despite contradictory efficacies reported in the literature, inhaled or nasal corticosteroids were used in 15.05% of visits for acute cases, the researchers said.

Within the class of antibiotics, penicillins, mainly amoxicillin and amoxicillin-clavulanate potassium (Augmentin), were the most commonly used medication class for both chronic and acute bacterial sinusitis, the investigators said.

Questionable, the researchers said, is the frequent use of the antibiotic class that included erythromycins, lincosamides, and macrolides, as well as other classes having higher antimicrobial efficacy. These drugs were used in 24.32% of acute visits, ahead of cephalosporins, sulfonamides and trimethprim, and tetracyclines.

The vast use of antibiotics suggests that they seem to be effective or they would have been abandoned, the researchers said. However, "To attribute efficacy or curative credit to a drug class based solely on resolution of symptoms without comparison with nontreated control subject, physicians could be oversatisifed with their own prescribing habits," the investigators concluded.

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