Antibiotic prescription for acute sinusitis in otherwise healthy adults. Clinical cure in relation to costs

Bock, Geertruida H. de; Erkel, AR van; Springer, M. P.; Kievit, J.

doi:10.1080/028134301300034729

Cited by 9 publications

(9 citation statements)

References 11 publications

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“…From a financial point of view such an approach is supported by meta‐analyses reported by de Bock et al . [22] and Benninger et al . [23].…”

Section: Discussionmentioning

confidence: 93%

“…Patients not initially prescribed an antibiotic in the current study could be considered to be treated using an approach similar to the 'watchful waiting' strategy and for most this did not fail. From a financial point of view such an approach is supported by meta-analyses reported by de Bock et al [22] and Benninger et al [23].These, respectively, showed that postponing initiation of the antibiotic treatment for 7 days is the most cost-effective strategy for AS and that overall expenses due to empirical antibiotic prescription to any patient would exceed initial and additional costs in case of treatment failure. However, although most patients with acute purulent sinusitis recover without antibiotic treatment, some could be exposed to the risk of serious complications and sequelae that include meningitis, brain abscess, orbital cellulites and orbital abscess [2].…”

Section: Figurementioning

confidence: 96%

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Effectiveness of antibiotics for acute sinusitis in real‐life medical practice

Blin

Blazejewski

Lignot

et al. 2010

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Determining bacterial aetiology of acute sinusitis is difficult without employing invasive procedures. • Most episodes of acute sinusitis resolve spontaneously. • Antibiotics have demonstrated efficacy for the treatment of acute bacterial sinusitis in clinical trials yet little is known of their effectiveness in real‐life treatment settings. WHAT THIS STUDY ADDS • Most cases of untreated acute sinusitis resolved spontaneously. Antibiotics were more effective when given within the first 10 days of treatment. This had no effect on later recurrence. • Patients with poor oro‐dental condition or recent antibiotic use may derive the most benefit from an antibiotic prescription and this should be considered by prescribers. • The antibiotics used were found to be equally effective. • Existing recommendations to identify acute sinusitis with high probability of bacterial origin, such as the French recommendations, fever or duration of symptoms fail to identify patients in whom antibiotics are more effective. AIMS To assess the effectiveness of antibiotics in acute bacterial sinusitis. METHODS This was a prospective cohort study with 2 months follow‐up of 5640 patients with acute sinusitis included by a random sample from 1174 GPs and 120 ENT specialists. Main outcomes were short‐term initial success, defined as the absence of prescription of (another) antibiotic or sinus lavage within 10 days, and lack of recurrence between the 11th and 60th day, after initial success. RESULTS Initial success was found in 88.7% (95% CI 85.1, 91.4%) of patients without antibiotic prescription at inclusion and 96.2% (95% CI 95.7, 96.7%) of patients prescribed antibiotics. The 10 day adjusted hazard ratio (HR) for treatment failure (new antibiotic prescription or sinus drainage) with initial antibiotics compared with no antibiotics was 0.30 (95% CI 0.21, 0.42) with no difference between antibiotics. Antibiotics were more effective in patients with poor oro‐dental condition (HR 0.04, 95% CI 0.01, 0.20) and in patients who had already used antibiotics during the previous 2 months (HR 0.09, 95% CI 0.03, 0.28). For patients without failure at 10 days, recurrence between the 11th and 60th day was similar whether or not they had initially been prescribed an antibiotic, 94.1% (95% CI 93.4, 94.7%) and 93.4% (95%CI 90.3, 95.5%), respectively. CONCLUSION Most acute sinusitis cases not prescribed antibiotics resolve spontaneously. Antibiotics reduced by 3.3‐fold the risk of failure within 10 days, without impact on later recurrence. The greatest benefit of antibiotics was found for patients with poor oro‐dental condition or with antibiotic use within the previous 2 months.

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“…From a financial point of view such an approach is supported by meta‐analyses reported by de Bock et al . [22] and Benninger et al . [23].…”

Section: Discussionmentioning

confidence: 93%

Section: Figurementioning

confidence: 96%

Effectiveness of antibiotics for acute sinusitis in real‐life medical practice

Blin

Blazejewski

Lignot

et al. 2010

Brit J Clinical Pharma

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“…They also acknowledged the self-limited nature of acute uncomplicated sinusitis. In another study, de Bock et al 31 used data from clinical trials to develop a costeffectiveness model to determine which treatment strategy was preferred in acute sinusitis. They concluded that postponing antibiotics for 1 week and thereby prescribing them selectively rather than prescribing them immediately was the most cost-effective strategy.…”

Section: Commentmentioning

confidence: 99%

Impact of First-Line vs Second-Line Antibiotics for the Treatment of Acute Uncomplicated Sinusitis

Piccirillo

Mager²,

Frisse³

et al. 2001

JAMA

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“…Delaying prescription of antibiotics to patients with acute sinusitis also helps in reducing the use of antibiotics. There is only a 3% difference in the cure rate after a week in patients with acute sinusitis whether they used antibiotics or not 48 …”

Section: Prescribing In Otorhinolaryngologymentioning

confidence: 99%

Combating bacterial resistance in otorhinolaryngology

Raghavan

Jones

2002

Clin Otolaryngol

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Bacterial resistance appears to be an ever-increasing problem and is threatening to spiral out of control. The scare caused by the rapid spread of methicillin-resistant Staphylococcus aureus among hospitals in the UK is the most recent. Otorhinolaryngology is deeply involved in this problem, as one of the reasons often cited for increasing bacterial resistance is the use of antibiotics in suspected bacterial infections in ear, nose and throat by primary care physicians. This speciality is also involved in the development of guidelines for antimicrobial use by primary and secondary care. This review attempts to discuss the reason for the development of antimicrobial resistance especially in relation to otorhinolaryngology, what can be done to contain this menace and the surveillance system developed to monitor the trend in the development of bacterial resistance.

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Antibiotic prescription for acute sinusitis in otherwise healthy adults. Clinical cure in relation to costs

Abstract: In patients presenting with acute sinusitis, postponing antibiotics for 1 week is the most cost-effective strategy.

Cited by 9 publications

References 11 publications

Effectiveness of antibiotics for acute sinusitis in real‐life medical practice

Effectiveness of antibiotics for acute sinusitis in real‐life medical practice

Impact of First-Line vs Second-Line Antibiotics for the Treatment of Acute Uncomplicated Sinusitis

Combating bacterial resistance in otorhinolaryngology

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