Antibiotics, steroids overused for sinusitis

NEW YORK (Reuters Health) - Evidence from national databases suggests that both acute and chronic sinus inflammation (sinusitis) is being overtreated with poorly chosen medications, researchers report.

Data from 1999 and 2002 collected by the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey suggests that there were roughly 14 million visits annually because of chronic sinusitis and 3 million because of acute sinusitis.

According to the Sinus and Allergy Health Partnership, acute sinusitis lasts for up to 4 weeks, while chronic cases last at least 12 weeks.

Hadley J. Sharp and associates at the University of Nebraska Medical Center in Omaha report that 83 percent of visits for acute sinusitis resulted in a prescription for an antibiotic, as did 70 percent of visits for chronic sinusitis.

"Prescription antibiotic drugs are being used far more than bacterial causes studies would indicate," the authors warn.

The investigators note that penicillins were used most frequently, which corresponds with the recommendations of the Partnership. However, next in line should be types of antibiotics known as erythromycins, lincosamides, and macrolides. But in reality, cephalosporins, sulfonamides, trimethoprim, and tetracyclines were more commonly used.

Inhaled steroids were prescribed approximately 15 percent to 16 percent of the time for acute and chronic sinusitis. Sharp's team maintains this frequency is higher "than published studies imply is necessary" for acute sinusitis, whereas it may actually be lower than indicated for chronic symptoms.

The only medication considered to be used judiciously was antihistamines, 25 percent of the time for acute sinusitis and 21 percent for the chronic illness.

While Sharp and associates question the judgment of the physicians who prescribe medications in these cases, they also wonder, "Could their use be more efficacious than proved? Can it be assumed that practicing physicians in the United States base their decisions on experienced success?"

After all, Sharp's team speculates, wouldn't physicians have abandoned use of these agents if they were ineffective?

Until evidence-based medicine indicates the appropriate tack to take, they conclude, personal or accumulated clinical experience is likely to rule the prescription pad.

SOURCE: Archives of Otolaryngology -- Head and Neck Surgery. March 19, 2007.