Antibiotics are prescribed in 83% of physician visits for acute rhinosinusitis and in 70% of visits for chronic rhinosinusitis, far more than is indicated by the expected rates of bacterial infection, reported Hadley J. Sharp and her associates at the University of Nebraska Medical Center, Omaha.
The investigators examined national trends in rhinosinusitis treatment using data from a probability sample of nearly 6,000 visits for ambulatory medical care to physicians' offices, hospital outpatient departments, and emergency departments.
The data were collected prospectively by the National Center for Health Statistics from 1999 through 2002, and represent more than an estimated 3 million annual visits for acute and 14 million visits for chronic rhinosinusitis.
Physicians ordered, supplied, administered, or continued at least one prescription antibiotic in 83% of visits for acute rhinosinusitis, representing an estimated 2.5 million cases, and in 70% of visits for chronic rhinosinusitis, representing an estimated 11.6 million cases.
Appropriately, penicillins—mainly amoxicillin and amoxicillin-clavulanate—were the most commonly prescribed antibiotics for both forms of sinusitis, given in about 30% of visits for each disorder.
Unexpectedly, erythromycins, lincosamides, and macrolides comprised the second most commonly used type of antibiotics, and they were prescribed in 24% of visits for acute and 14% of visits for chronic sinusitis. These agents have a lower clinical and bacteriologic efficacy than cephalosporins, sulfonamides, and trimethoprim (Arch. Otolaryngol. Head Neck Surg. 2007;133:260–5).