Adults with the common rhinosinusitis infection should not be prescribed antibiotics, even if the symptoms are reported as lasting longer than 7-10 days, according to an Article released on March 14, 2008 in The Lancet.
The third most common reason for a patient to consult a doctor is an upper respiratory tract infection. Rhinosinusitis, or infection of the nose and sinuses, is identified in its acute form in approximately one third of these cases. Unfortunately, it is very difficult to distinguish between the viral and bacterial forms of this disease, so doctors have a tendency to overprescribe antibiotics. Overprescription of antibiotics can contribute to rates of antibiotic resistance, and microbes with resistance lead to higher rates of disease and death throughout the world. In the United States, 80% of all patients with the diagnosis of rhinosinusitis are prescribed an antibiotic, and in Europe this statistic ranges from 72-92%.
To investigate how rhinosinusitis could be affecting this trend, Dr Jim Young, Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland, and colleagues, performed a meta-analysis in which they pooled data from 2547 adults from nine different trials. The patients had rhinosinusitis-like complaints and were randomly assigned to treatment with an antibiotic or a placebo. The authors then examined the overall effects of the antibiotic treatment as it correlated with the prognostic value of common signs and symptoms by looking at the number of them needed to treat (NNT) with antibiotics in order to cure a patient.
They found that 15 patients diagnosed with rhinosinusitis had to be given antibiotics before an additional patient was cured. When the patients were limited to those with a phlegm-like discharge from the throat, this NNY reduced to 8. When patients were older, reported symptoms for longer, or reported more severe symptoms, recovery took longer, but they were no more likely to benefit from antibiotics than were other patients.
According to the authors, this means that antibiotics often are ineffective to treating acute rhinosinusitis symptoms. “The implication for primary care is that antibiotics offer little benefit for patients with acute rhinosinusitis-like complaints. Common clinical signs and symptoms cannot identify a subgroup for which treatment is clearly justified, given the cost, events, and bacterial resistance associated with antibiotic use. Antibiotics are not justified even if a patient reports symptoms for longer than 7-10 days.”
The authors conclude with advice for physicians. “Although our results do not apply to children or patients with a suppressed immune system, they should reassure physicians that only watchful waiting and symptomatic relief are warranted for almost all adult patients with acute rhinosinusitis-like complaints.”
Dr Morten Lindbaek, Antibiotic Centre for Primary Care, University of Oslo, Norway, and Dr Christopher Butler, Centre for Health Sciences Research, School of Medicine, Cardiff University, UK, contributed an accompanying Comment in which they call for a more strict definition of rhinosinusitis and related symptoms. “Young and colleagues have shown that if any subgroups of patients with mild sinusitis respond substantially to antibiotic treatment, these subgroups are not easy to identify…..Perhaps the time has come for researchers to agree on common definitions, a minimum dataset, at least one standard outcome, and best mode of administration for treatment trials in common infections? Such consensus could pave the way for major changes in treatment.”
Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data
Jim Young, An De Sutter, Dan Merenstein, Gerrit A van Essen, Laurent Kaiser, Helena Varonen, Ian Williamson, Heiner C Bucher
The Lancet – Vol. 371, Issue 9616, 15 March 2008, Pages 908-914
Antibiotics for sinusitis-like symptoms in primary care
Morten Lindbaek, Christopher C Butler
The Lancet – Vol. 371, Issue 9616, 15 March 2008, Pages 874-876
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Written by Anna Sophia McKenney