Background Several studies have shown that the use of antibiotics early in life significantly increases the risk of asthma in children. It is unclear whether antibiotics are more commonly used in patients with allergy-related diseases. Methods A multistage, clustered and random sampling with a field-interviewer-administrated survey study was performed to investigate if there was multiple use of antibiotics (MUA) in patients with allergic rhinitis (AR), conjunctivitis, chronic urticaria (CU), and asthma in the grasslands of northern China. MUA was defined as antibiotic usage for at least 3 days and for more than 3 times a year in the past 2 years. Results A total of 5,787 subjects completed the study, with 1,079 subjects (18.6%) identified as MUA. MUA was more common in patients with AR (23.7% vs 16.2%, P <0.001), conjunctivitis (22.5% vs 17.1%, P <0.001), asthma (31.8% vs 17.7%, P <0.001), and CU (25.9% vs 18.3%, P <0.01) than in subjects without allergic diseases. There is an increasing percentage of MUA in patients with a single, two, and three or more diseases both in children (20.1%, 25.0%, and 31.4%, respectively, P =0.014) and in adults (19.1%, 23.4%, and 32.9%, respectively, P <0.001). MUA is significantly associated with AR (OR=1.7, 95% CI: 1.3–2.1, P <0.001), conjunctivitis (OR=1.6, 95% CI: 1.2–2.1, P =0.001), asthma (OR=2.3, 95% CI:1.6–3.3, P <0.001) and CU (OR=2.1, 95% CI: 1.2–3.6, P =0.006) in children aged 2–17 years; and in adults (≥18 years old) for AR (OR=1.7, 95% CI: 1.4–2.1, P <0.001), conjunctivitis (OR=1.3, 95% CI:1.1–1.6, P =0.002), and asthma (OR=2.0, 95% CI: 1.5–2.7, P <0.001). Conclusion Antibiotic overuse might be associated with increased risk of allergy-related disease. It is important that implementation of the evidence-based international guidelines for the management of allergy-related diseases needs to be improved, in order to avoid unnecessary use of antibiotics.

Background: Acute rhinosinusitis (ARS) is one of the most common diagnoses for which an antibiotic is prescribed. Although the usage of antibiotics in the treatment of mild, moderate or uncomplicated ARS is not recommended by most international guidelines, overuse of antibiotics is still an alarming problem among patients and healthcare practitioners. We thus sought to review the evidence available through a systematic review of the existing literature on antibiotic usage in ARS. Methodology: A search of the PubMed database was conducted for studies on antibiotic and placebo usage in the treatment of ARS. Results: A total of 31 random control trials (RCT) reporting the clinical efficacy of treating ARS and side effects of using cefuroxime axetil, telithromycin, amoxicillin/potassium clavulanate, levofloxacin, moxifloxacin and clarithromycin were included in the review. Among them, 9 studies were performed double-blinded with placebo controls. The results showed that while antibiotics are more efficacious than placebos in the treatment of ARS, the risks of potential side effects need to be weighed against the potential benefit that antibiotics give to the patient. This is especially pertinent as usage of the placebo has shown to be almost as efficacious as using the antibiotic therapy, and also much safer. Conclusion: The usage of antibiotics in ARS is widespread and there seems to be only slight added benefit in the usage of antibiotics over placebo in the treatment of ARS. Hence, larger scale studies should be done in the future to confirm the results of these studies.