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Hoogland J, Takada T, van Smeden M, Rovers MM, de Sutter AI, Merenstein D, Kaiser L, Liira H, Little P, Bucher HC, Moons KGM, Reitsma JB, Venekamp RP. Prognosis and prediction of antibiotic benefit in adults with clinically diagnosed acute rhinosinusitis: an individual participant data meta-analysis. Diagn Progn Res 2023; 7:16. [PMID: 37667327 PMCID: PMC10478354 DOI: 10.1186/s41512-023-00154-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/20/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND A previous individual participant data meta-analysis (IPD-MA) of antibiotics for adults with clinically diagnosed acute rhinosinusitis (ARS) showed a marginal overall effect of antibiotics, but was unable to identify patients that are most likely to benefit from antibiotics when applying conventional (i.e. univariable or one-variable-at-a-time) subgroup analysis. We updated the systematic review and investigated whether multivariable prediction of patient-level prognosis and antibiotic treatment effect may lead to more tailored treatment assignment in adults presenting to primary care with ARS. METHODS An IPD-MA of nine double-blind placebo-controlled trials of antibiotic treatment (n=2539) was conducted, with the probability of being cured at 8-15 days as the primary outcome. A logistic mixed effects model was developed to predict the probability of being cured based on demographic characteristics, signs and symptoms, and antibiotic treatment assignment. Predictive performance was quantified based on internal-external cross-validation in terms of calibration and discrimination performance, overall model fit, and the accuracy of individual predictions. RESULTS Results indicate that the prognosis with respect to risk of cure could not be reliably predicted (c-statistic 0.58 and Brier score 0.24). Similarly, patient-level treatment effect predictions did not reliably distinguish between those that did and did not benefit from antibiotics (c-for-benefit 0.50). CONCLUSIONS In conclusion, multivariable prediction based on patient demographics and common signs and symptoms did not reliably predict the patient-level probability of cure and antibiotic effect in this IPD-MA. Therefore, these characteristics cannot be expected to reliably distinguish those that do and do not benefit from antibiotics in adults presenting to primary care with ARS.
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Affiliation(s)
- Jeroen Hoogland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Department of Epidemiology and Data Science, Amsterdam University Medical Centres, Amsterdam University, Amsterdam, The Netherlands.
| | - Toshihiko Takada
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maroeska M Rovers
- Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - An I de Sutter
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Laurent Kaiser
- Department of Medicine, Division of Infectious Diseases, University Hospital Geneva, Geneva, Switzerland
| | - Helena Liira
- Department of General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Australia
- Department of General Practice and Primary Care, University of Helsinki, Helsinki, Finland
| | - Paul Little
- Primary Care & Population Sciences Unit, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Heiner C Bucher
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Hassan F, Sher M, Hussain MA, Saadia M, Naeem-Ul-Hassan M, Rehman MFU, Haseeb MT, Bukhari SNA, Abbas A, Peng B, Kanwal F, Deng H. Pharmaceutical and Pharmacological Evaluation of Amoxicillin after Solubility Enhancement Using the Spray Drying Technique. ACS OMEGA 2022; 7:48506-48519. [PMID: 36591136 PMCID: PMC9798760 DOI: 10.1021/acsomega.2c06662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
The dose frequency of drugs belonging to class II is usually high and associated with harmful effects on the body. The study aimed to enhance the solubility of the poorly water-soluble drug amoxicillin (AM) by the solid dispersion (SD) technique. Six different SDs of AM, F1-F6, were prepared by the spray drying technique using two other carriers, HP-β-CD (F1-F3) and HPMC (F4-F6), in 1:1, 1:2, and 1:3 drug-to-polymer ratios. These SDs were analyzed to determine their practical yield, drug content, and aqueous solubility using analytical techniques such as Fourier transform infrared spectroscopy, scanning electron microscopy, thermogravimetric analysis, and powder X-ray diffraction. The effect of polymer concentration on SDs was determined using aqueous solubility, in vitro dissolution, and in vivo studies. The results showed no drug-polymer interactions in SDs. Solubility studies showed that SDs based on the drug-to-polymer ratio of 1:2 (F2 and F5) were highly soluble in water compared to those with ratios of 1:1 and 1:3. In vitro dissolution studies also showed that SDs with a ratio of 1:2 released the highest drug concentration from both polymeric systems. The SDs based on HPMC confirmed the more sustained release of the drug as compared to that of HP-β-CD. All the SDs were observed as stable and amorphous, with a smooth spherical surface. In vivo studies reveal the enhancement of pharmacokinetics parameters as compared to standard AM. Hence, it is confirmed that spray drying is an excellent technique to enhance the solubility of AM in an aqueous medium. This may contribute to the enhancement of the pharmacokinetic behaviors of SDs.
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Affiliation(s)
- Faiza Hassan
- Institute
of Chemistry, University of Sargodha, Sargodha40100, Pakistan
| | - Muhammad Sher
- Institute
of Chemistry, University of Sargodha, Sargodha40100, Pakistan
| | | | - Mubshara Saadia
- Department
of Chemistry, Ghazi University, Dera Ghazi Khan32200, Pakistan
| | | | | | | | - Syed Nasir Abbas Bukhari
- Department
of Pharmaceutical Chemistry, College of Pharmacy, Jouf University, Sakaka, Aliouf2014, Saudi Arabia
| | - Azhar Abbas
- Institute
of Chemistry, University of Sargodha, Sargodha40100, Pakistan
- Department
of Cardiothoracic Surgery, The Second Affiliated
Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong510006, China
| | - Bo Peng
- Government
Ambala Muslim Graduate College, Sargodha40100, Pakistan
| | - Fariha Kanwal
- School
of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai201620, China
| | - Huibiao Deng
- Department
of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200127, China
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3
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Ito A, Watanabe Y, Okumura T. Patients’ acceptance of placebo antibiotics in Japan: a prescription for antimicrobial resistance. J Pharm Policy Pract 2022; 15:79. [PMID: 36348416 PMCID: PMC9641938 DOI: 10.1186/s40545-022-00470-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background The generalized use of antibiotics has led to the emergence of bacteria which are resistant to antimicrobial agents. This stems in part from the patient's tendencies to seek antibiotics for diseases when not necessary. Hence, this article investigated patient acceptance of prescribing placebos as a substitute for unnecessary antibiotics in Japan, where physicians are under severe time constraints and are unable to offer explanations and persuade patients who demand unnecessary antibiotics prescription. Methods A web-based questionnaire was administered to assess patients’ acceptance of the placebo treatment under informed consent. One thousand participants representing all genders and age-class were randomly selected from the online panel of a web-survey company. Results The results showed that 67.9% of the participants were “satisfied” to receive such treatments, whereas 20.6% indicated acceptance of the prescription but without satisfaction. In total, 88.5% of the participants accepted the prescription of placebo, a result consistent with that of a preceding study on placebo treatments conducted in the United States. In the survey, tone of persuasion did not affect the patients’ attitudes; however, patients who were loyal to their physicians exhibited lower refusal rates. Conclusion The survey results showed that the prescription of “ethical placebos” could be an acceptable option for the patients in Japan. For ethical concerns, an additional literature survey was conducted and the result suggested that such a radical treatment option could be justified, provided that the prescription benefits patients and informed consent is properly obtained. Albeit it is impractical to use, because of ethical and operational concerns, it would be worth further investigation to ensure diversity in the countermeasures for antimicrobial resistance, a major public health threat nowadays. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-022-00470-8.
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4
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Smith SS, Kim R, Douglas R. Is there a role for antibiotics in the treatment of chronic rhinosinusitis? J Allergy Clin Immunol 2022; 149:1504-1512. [PMID: 35217148 PMCID: PMC11185277 DOI: 10.1016/j.jaci.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/15/2022]
Abstract
Rhinosinusitis is one of the most common reasons for adult outpatient antibiotic prescriptions, though there is little clinical evidence to support this practice, especially for chronic rhinosinusitis. Despite considerable research, the etiology of chronic rhinosinusitis, including the pathogenic role of microbes, remains poorly understood. Rigorous studies of the efficacy of antibiotic treatment of chronic sinusitis are surprisingly few in number and the results are somewhat conflicting. This review article will review the rationales for and against the treatment of chronic rhinosinusitis with antibiotics, based on current evidence and understanding of pathophysiology, and will also summarize the current guidelines.
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Affiliation(s)
- Stephanie Shintani Smith
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill; Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Raymond Kim
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Richard Douglas
- Department of Surgery, The University of Auckland, Auckland, New Zealand
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Machado-Duque ME, García DA, Emura-Velez MH, Gaviria-Mendoza A, Giraldo-Giraldo C, Machado-Alba JE. Antibiotic Prescriptions for Respiratory Tract Viral Infections in the Colombian Population. Antibiotics (Basel) 2021; 10:864. [PMID: 34356785 PMCID: PMC8300612 DOI: 10.3390/antibiotics10070864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Antimicrobials are frequently inappropriately prescribed for the management of upper respiratory tract infections (URTIs); therefore, the frequency of antibiotic prescriptions for patients with viral URTIs was assessed in this study. A cross-sectional study, including ambulatory patients diagnosed with viral URTI, was conducted, and records of antimicrobial prescriptions were obtained. Sociodemographic, clinical (diagnostic), and pharmacological (antimicrobial) variables were assessed. Through multivariate analysis, variables associated with the use of antibiotics for viral infections were identified. A total of 341,182 patients with viral URTIs were identified. The patients, who were from 26 different departments of Colombia, had a mean age of 29.7 ± 23.5 years and a female predominance of 58.7% (n = 200,195). The most frequent viral infections were as follows: acute rhinopharyngitis (common cold) (n = 206,211; 60.4%); unspecified acute tonsillitis (n = 27,432; 8.0%); and acute pharyngitis (n = 26,411; 7.7%). A total of 24.8% of the patients (n = 84,453) received a prescription for antibiotics, predominantly penicillins (n = 61,871; 18.1%) and cephalosporins (n = 10,926; 3.2%). Patients treated in Atlántico, Valle, and Risaralda departments, along with those older than 5 years, were more likely to receive antibiotics for the treatment of viral infections. Antibiotics are frequently prescribed for the management of URTIs, which is considered an inappropriate practice due to a lack of clinical benefits, increased generation of antimicrobial resistance, and a risk of adverse reactions due to the use of medications that patients do not require. Drug utilization studies are a great tool for monitoring how antibiotics are being used and planning interventions to improve their use.
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Affiliation(s)
- Manuel E. Machado-Duque
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira 660003, Colombia; (M.E.M.-D.); (A.G.-M.); (C.G.-G.)
- Grupo de Investigación Biomedicina, Fundación Universitaria Autónoma de las Américas, Pereira 660003, Colombia; (D.A.G.); (M.H.E.-V.)
| | - Diego Arturo García
- Grupo de Investigación Biomedicina, Fundación Universitaria Autónoma de las Américas, Pereira 660003, Colombia; (D.A.G.); (M.H.E.-V.)
| | - Melissa Hiromi Emura-Velez
- Grupo de Investigación Biomedicina, Fundación Universitaria Autónoma de las Américas, Pereira 660003, Colombia; (D.A.G.); (M.H.E.-V.)
| | - Andrés Gaviria-Mendoza
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira 660003, Colombia; (M.E.M.-D.); (A.G.-M.); (C.G.-G.)
- Grupo de Investigación Biomedicina, Fundación Universitaria Autónoma de las Américas, Pereira 660003, Colombia; (D.A.G.); (M.H.E.-V.)
| | - Claudia Giraldo-Giraldo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira 660003, Colombia; (M.E.M.-D.); (A.G.-M.); (C.G.-G.)
| | - Jorge E. Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira 660003, Colombia; (M.E.M.-D.); (A.G.-M.); (C.G.-G.)
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6
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Gregory J, Huynh B, Tayler B, Korgaonkar-Cherala C, Garrison G, Ata A, Sorum P. High-Dose vs Standard-Dose Amoxicillin Plus Clavulanate for Adults With Acute Sinusitis: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e212713. [PMID: 33755168 PMCID: PMC7988367 DOI: 10.1001/jamanetworkopen.2021.2713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Acute bacterial sinusitis is common, but currently recommended antibiotic treatment provides minimal benefit. OBJECTIVE To confirm the previous finding that high-dose amoxicillin plus clavulanate (with double the amount of amoxicillin) may be superior to standard-dose amoxicillin plus clavulanate in adults. DESIGN, SETTING, AND PARTICIPANTS This double-blind, comparative-effectiveness randomized clinical trial was conducted from February 26, 2018, through May 10, 2020, at the academic primary care internal medicine and pediatrics practice of Albany Medical Center, located in Cohoes, New York. Participants included adults aged 18 years or older who were prescribed amoxicillin plus clavulanate for acute bacterial sinusitis diagnosed in accordance with the Infectious Diseases Society of America guidelines. INTERVENTIONS Amoxicillin 875 mg with clavulanate 125 mg plus either placebo (standard dose) or amoxicillin 875 mg (high dose) twice a day for 7 days. MAIN OUTCOMES AND MEASURES The primary efficacy outcome was a global rating of "a lot better" or "no symptoms" at the end of 3 days of treatment using a Global Rating of Improvement scale, with outcomes ranging from 1 (a lot worse) to 6 (no symptoms). The primary adverse effect outcome was severe diarrhea at 3 or 10 days after the start of treatment. RESULTS At an unplanned interim analysis prompted by COVID-19 restrictions, 157 of a projected 240 participants had been enrolled (mean age, 48.5 [range, 18.7-84.0] years; 117 women [74.5%]), with 79 randomized to the standard dose and 78 to the high dose; 9 and 12, respectively, withdrew or were lost to follow-up before the assessment of the primary outcome. At day 3, 31 of 70 participants (44.3%) in the standard-dose group reported a global rating of "a lot better" or "no symptoms," as did 24 of 66 (36.4%) in the high-dose group, for a difference of -7.9% (95% CI, -24.4% to 8.5%; P = .35). The study was, therefore, stopped for futility. Diarrhea was common in both groups by day 3, with any diarrhea reported in 29 of 71 participants (40.8%) receiving the standard dose and 28 of 65 (43.1%) receiving the high dose and severe diarrhea reported in 5 of 71 (7.0%) and 5 of 65 (7.7%), respectively. CONCLUSIONS AND RELEVANCE The results of this randomized clinical trial suggest that adults treated for clinically diagnosed acute sinusitis did not appear to benefit from taking high-dose compared with standard-dose amoxicillin plus clavulanate. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03431337.
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Affiliation(s)
- Jennifer Gregory
- Medicine and Pediatrics, Albany Medical Center Hospital, Cohoes, New York
- Englewood Health Medical Center, Englewood, New Jersey
| | - Bichtram Huynh
- Medicine and Pediatrics, Albany Medical Center Hospital, Cohoes, New York
| | - Brittany Tayler
- Medicine and Pediatrics, Albany Medical Center Hospital, Cohoes, New York
| | - Chaitali Korgaonkar-Cherala
- Albany Medical College, Albany, New York
- Department of Obstetrics-Gynecology, Stony Brook University Hospital, Stony Brook, New York
| | - Gina Garrison
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York
| | - Ashar Ata
- Department of Surgery, Albany Medical College, Albany, New York
- Department of Emergency Medicine, Albany Medical College, Albany, New York
| | - Paul Sorum
- Department of Internal Medicine, Albany Medical College, Albany, New York
- Department of Pediatrics, Albany Medical College, Albany, New York
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Stockert K. Allergie, Mikrobiom und weitere epigenetische Faktoren. ALLERGIEPRÄVENTION 2020. [PMCID: PMC7123400 DOI: 10.1007/978-3-662-58140-7_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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8
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Update on the diagnostic considerations for neurogenic nasal and sinus symptoms: A current review suggests adding a possible diagnosis of migraine. Am J Otolaryngol 2019; 40:306-311. [PMID: 30473169 DOI: 10.1016/j.amjoto.2018.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 09/30/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Treatment of rhinosinusitis (RS) is one of the leading reasons for prescriptions of antibiotics, although they often fail to provide symptomatic relief. Appropriately diagnosing and treating patients presenting with RS for whom antibiotic therapy has failed or who have normal CT findings is a controversial topic. One explanation is that what these patients are experiencing is misinformation from the trigeminal nerve and autonomic nervous system. Midfacial pain and pressure with rhinorrhea and nasal congestion do not represent an infectious, or even inflammatory, condition within the sinus or nasal cavities, but a mirage that is best treated as a migraine variant. Observations Although there is not enough research to definitively prove this alternate etiology, we are reaching a tipping point where the clinical implications, real-world experience, and evolving literature support this possible alternate etiology. Four key factors support a midfacial migraine that mimics RS: 1) Pathophysiology: current pathophysiology literature offers a model of how migraine attacks could replicate clinical presentations of RS; 2) Clinical presentation: patients with infectious RS and midfacial migraine have similar symptomatic presentation, similar demographics, but poorly correlated radiological information; 3) Diagnosis: clinical studies support the proposition that there are alternative diagnostic tools for distinguishing patients with midfacial migraine; and 4) Prognosis: Select RS patients show significant improvement with migraine treatment. CONCLUSIONS We encourage medical professionals to consider migraine disease as a form of sensory misinformation and as a possible etiology of RS complaints. Clinicians can ask validated questions to determine if possible migraine could be an underlying cause, and there are standard preventative treatments for migraine that could alleviate patient symptoms. Dysfunctional vasomotor activity may be the root of the disturbances, particularly when antibiotic therapy fails and CT findings are discordant with symptoms. Until there is a diagnostic test for migraine, clinicians need to question a patient's self-diagnosis of rhinosinusitis. More research is needed to definitively answer this important question.
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9
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O’Connor R, O’Doherty J, O’Regan A, O’Neill A, McMahon C, Dunne CP. Medical management of acute upper respiratory infections in an urban primary care out-of-hours facility: cross-sectional study of patient presentations and expectations. BMJ Open 2019; 9:e025396. [PMID: 30772860 PMCID: PMC6398638 DOI: 10.1136/bmjopen-2018-025396] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/12/2018] [Accepted: 01/02/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The purpose of this study was to examine the expectations of patients attending an urban primary care out-of-hours (OOH) facility with acute upper respiratory tract infection (acute URTI) regarding clinical examination, symptom management, information on their condition, reassurance, antibiotic treatment and other possible options including referral. DESIGN Cross-sectional design. SETTING One urban primary care OOH facility located in the midwest of Ireland. PARTICIPANTS 457 patients filled out a questionnaire while waiting in the OOH facility; 22 surveys were excluded as the patients did not present with symptoms of acute URTI resulting in 435 patients' data being included in this study. There were 59.5% female participants and 40.5% male participants. RESULTS 435 patients with acute URTI symptoms participated in the survey, representing 25.4% of those attending the single branch where the survey was conducted (n=1715). Of the study participants, 43% were aged under 6 years and 60% were women. The most common presenting symptoms were cough (72%), throat ache (46%) and common cold (26%). The most common expectations were for further examination (53%), reassurance (51%), information (49%) and medication for cough (47%), with 34% expecting an antibiotic. CONCLUSIONS Only one in three patients attending this primary care OOH facility with acute URTI symptoms had an expectation of antibiotics, with most seeking further assessment, information and reassurance. Recognition of such expectations may be important considerations for clinicians when deciding on management options for patients with acute URTI.
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Affiliation(s)
- Raymond O’Connor
- Graduate Entry Medical School, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
| | - Jane O’Doherty
- Graduate Entry Medical School, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
| | - Andrew O’Regan
- Graduate Entry Medical School, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
| | - Aoife O’Neill
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Claire McMahon
- Clinical Quality and Administration Department, Shannondoc Out of Hours General Practitioner Service, Limerick, Ireland
| | - Colum P Dunne
- Graduate Entry Medical School, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
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10
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Dilger AE, Peters AT, Wunderink RG, Tan BK, Kern RC, Conley DB, Welch KC, Holl JL, Smith SS. Procalcitonin as a Biomarker in Rhinosinusitis: A Systematic Review. Am J Rhinol Allergy 2018; 33:103-112. [PMID: 30871341 DOI: 10.1177/1945892418810293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES (1) To describe the existing literature on procalcitonin (PCT) as a biomarker in patients with acute rhinosinusitis (ARS), (2) to analyze outcomes in ARS patients who were treated with PCT-guided therapy versus traditional management, and (3) to compare PCT to other biomarkers used in diagnosis of bacterial ARS. Data Sources: PubMed and Embase. Review Methods: A systematic search in the PubMed and Embase databases was performed to identify studies related to PCT as a biomarker in ARS. After critical appraisal of validity by 2 authors, 6 studies with a total of 313 patients were selected for data extraction and analysis. We identified 2 randomized control trials (RCTs) of PCT-based guidelines for antibiotic management of ARS in outpatient settings and 4 observational studies that compared PCT to other biomarkers in patients with ARS. RESULTS The 2 RCTs demonstrated a reduction (41.6% in 1 study and 71% in the other) in antibiotic prescription rate in the PCT-guided group versus the control group with no change in the number of days with impaired activity due to illness (9.0 vs 9.0 days [ P = .96]; 8.1 vs 8.2 days [95% confidence interval -0.7 to 0.7]), number of days of work missed, and percentage of patients with persistent symptoms at 28 days. In the observational cohort studies, PCT did not consistently correlate with C-reactive protein, body temperature, and/or white blood cell counts. CONCLUSIONS The limited existing literature on the role of PCT in diagnosis, management, and prediction of clinical outcomes in ARS suggests that PCT-based guidelines for antibiotic prescription are a safe and effective method of minimizing unnecessary antibiotic use.
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Affiliation(s)
- Amanda E Dilger
- 1 Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anju T Peters
- 2 Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard G Wunderink
- 3 Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bruce K Tan
- 1 Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert C Kern
- 1 Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David B Conley
- 1 Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kevin C Welch
- 1 Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jane L Holl
- 4 Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephanie Shintani Smith
- 1 Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,4 Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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11
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O'Connor R, O'Doherty J, O'Regan A, Dunne C. Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review. Ir J Med Sci 2018; 187:969-986. [PMID: 29532292 PMCID: PMC6209023 DOI: 10.1007/s11845-018-1774-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/23/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Antimicrobial resistance is an emerging global threat to health and is associated with increased consumption of antibiotics. Seventy-four per cent of antibiotic prescribing takes place in primary care. Much of this is for inappropriate treatment of acute respiratory tract infections. AIMS To review the published literature pertaining to antibiotic prescribing in order to identify and understand the factors that affect primary care providers' prescribing decisions. METHODS Six online databases were searched for relevant paper using agreed criteria. One hundred ninety-five papers were retrieved, and 139 were included in this review. RESULTS Primary care providers are highly influenced to prescribe by patient expectation for antibiotics, clinical uncertainty and workload induced time pressures. Strategies proven to reduce such inappropriate prescribing include appropriately aimed multifaceted educational interventions for primary care providers, mass media educational campaigns aimed at healthcare professionals and the public, use of good communication skills in the consultation, use of delayed prescriptions especially when accompanied by written information, point of care testing and, probably, longer less pressurised consultations. Delayed prescriptions also facilitate focused personalised patient education. CONCLUSION There is an emerging consensus in the literature regarding strategies proven to reduce antibiotic consumption for acute respiratory tract infections. The widespread adoption of these strategies in primary care is imperative.
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Affiliation(s)
- Ray O'Connor
- Graduate Entry Medical School, University of Limerick, Limerick City, Limerick, 000, Ireland.
| | - Jane O'Doherty
- Graduate Entry Medical School, University of Limerick, Limerick City, Limerick, 000, Ireland
| | - Andrew O'Regan
- Graduate Entry Medical School, University of Limerick, Limerick City, Limerick, 000, Ireland
| | - Colum Dunne
- Graduate Entry Medical School, University of Limerick, Limerick City, Limerick, 000, Ireland
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Lemiengre MB, van Driel ML, Merenstein D, Liira H, Mäkelä M, De Sutter AIM. Antibiotics for acute rhinosinusitis in adults. Cochrane Database Syst Rev 2018; 9:CD006089. [PMID: 30198548 PMCID: PMC6513448 DOI: 10.1002/14651858.cd006089.pub5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Acute rhinosinusitis is an acute infection of the nasal passages and paranasal sinuses that lasts less than four weeks. Diagnosis of acute rhinosinusitis is generally based on clinical signs and symptoms in ambulatory care settings. Technical investigations are not routinely performed, nor are they recommended in most countries. Some trials show a trend in favour of antibiotics, but the balance of benefit versus harm is unclear.We merged two Cochrane Reviews for this update, which comprised different approaches with overlapping populations, resulting in different conclusions. For this review update, we maintained the distinction between populations diagnosed by clinical signs and symptoms, or imaging. OBJECTIVES To assess the effects of antibiotics versus placebo or no treatment in adults with acute rhinosinusitis in ambulatory care settings. SEARCH METHODS We searched CENTRAL (2017, Issue 12), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (January 1950 to January 2018), Embase (January 1974 to January 2018), and two trials registers (January 2018). We also checked references from identified trials, systematic reviews, and relevant guidelines. SELECTION CRITERIA Randomised controlled trials of antibiotics versus placebo or no treatment in people with rhinosinusitis-like signs or symptoms or sinusitis confirmed by imaging. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data about cure and side effects and assessed the risk of bias. We contacted trial authors for additional information as required. MAIN RESULTS We included 15 trials involving 3057 participants. Of the 15 included trials, 10 appeared in our 2012 review, and five (631 participants) are legacy trials from merging two reviews. No new studies were included from searches for this update. Overall, risk of bias was low. Without antibiotics, 46% of participants with rhinosinusitis, whether or not confirmed by radiography, were cured after 1 week and 64% after 14 days. Antibiotics can shorten time to cure, but only 5 to 11 more people per 100 will be cured faster if they receive antibiotics instead of placebo or no treatment: clinical diagnosis (odds ratio (OR) 1.25, 95% confidence interval (CI) 1.02 to 1.54; number needed to treat for an additional beneficial outcome (NNTB) 19, 95% CI 10 to 205; I² = 0%; 8 trials; high-quality evidence) and diagnosis confirmed by radiography (OR 1.57, 95% CI 1.03 to 2.39; NNTB 10, 95% CI 5 to 136; I² = 0%; 3 trials; moderate-quality evidence). Cure rates with antibiotics were higher when a fluid level or total opacification in any sinus was found on computed tomography (OR 4.89, 95% CI 1.75 to 13.72; NNTB 4, 95% CI 2 to 15; 1 trial; moderate-quality evidence). Purulent secretion resolved faster with antibiotics (OR 1.58, 95% CI 1.13 to 2.22; NNTB 10, 95% CI 6 to 35; I² = 0%; 3 trials; high-quality evidence). However, 13 more people experienced side effects with antibiotics compared to placebo or no treatment (OR 2.21, 95% CI 1.74 to 2.82; number needed to treat for an additional harmful outcome (NNTH) 8, 95% CI 6 to 12; I² = 16%; 10 trials; high-quality evidence). Five fewer people per 100 will experience clinical failure if they receive antibiotics instead of placebo or no treatment (Peto OR 0.48, 95% CI 0.36 to 0.63; NNTH 19, 95% CI 15 to 27; I² = 21%; 12 trials; high-quality evidence). A disease-related complication (brain abscess) occurred in one participant (of 3057) one week after receiving open antibiotic therapy (clinical failure, control group). AUTHORS' CONCLUSIONS The potential benefit of antibiotics to treat acute rhinosinusitis diagnosed either clinically (low risk of bias, high-quality evidence) or confirmed by imaging (low to unclear risk of bias, moderate-quality evidence) is marginal and needs to be seen in the context of the risk of adverse effects. Considering antibiotic resistance, and the very low incidence of serious complications, we conclude there is no place for antibiotics for people with uncomplicated acute rhinosinusitis. We could not draw conclusions about children, people with suppressed immune systems, and those with severe sinusitis, because these populations were not included in the available trials.
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Affiliation(s)
- Marieke B Lemiengre
- Ghent UniversityDepartment of Family Medicine and Primary Health CareCampus UZ 6K3, Corneel Heymanslaan 10GhentBelgium9000
| | - Mieke L van Driel
- Ghent UniversityDepartment of Family Medicine and Primary Health CareCampus UZ 6K3, Corneel Heymanslaan 10GhentBelgium9000
- Bond UniversityCentre for Research in Evidence‐Based Practice (CREBP)Gold CoastQueenslandAustralia4229
- The University of QueenslandPrimary Care Clinical Unit, Faculty of MedicineBrisbaneQueenslandAustralia4029
| | - Dan Merenstein
- Georgetown University Medical CenterDepartment of Family Medicine215 Kober Cogan Hall3750 Reservoir Road, NWWashingtonDCUSA20007
| | | | - Marjukka Mäkelä
- THL (National Institute for Health and Welfare)PO Box 30HelsinkiFinland00271
- University of CopenhagenDepartment of Public Health / Unit of General PracticeP.O.Box 2099DK‐1014 CopenhagenDenmark
| | - An IM De Sutter
- Ghent UniversityDepartment of Family Medicine and Primary Health CareCampus UZ 6K3, Corneel Heymanslaan 10GhentBelgium9000
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Matho A, Mulqueen M, Tanino M, Quidort A, Cheung J, Pollard J, Rodriguez J, Swamy S, Tayler B, Garrison G, Ata A, Sorum P. High-dose versus standard-dose amoxicillin/clavulanate for clinically-diagnosed acute bacterial sinusitis: A randomized clinical trial. PLoS One 2018; 13:e0196734. [PMID: 29738561 PMCID: PMC5940197 DOI: 10.1371/journal.pone.0196734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/17/2018] [Indexed: 11/18/2022] Open
Abstract
Background The recommended treatment for acute bacterial sinusitis in adults, amoxicillin with clavulanate, provides only modest benefit. Objective To see if a higher dose of amoxicillin will lead to more rapid improvement. Design, setting, and participants Double-blind randomized trial in which, from November 2014 through February 2017, we enrolled 315 adult outpatients diagnosed with acute sinusitis in accordance with Infectious Disease Society of America guidelines. Interventions Standard-dose (SD) immediate-release (IR) amoxicillin/clavulanate 875 /125 mg (n = 159) vs. high-dose (HD) (n = 156). The original HD formulation, 2000 mg of extended-release (ER) amoxicillin with 125 mg of IR clavulanate twice a day, became unavailable half way through the study. The IRB then approved a revised protocol after patient 180 to provide 1750 mg of IR amoxicillin twice a day in the HD formulation and to compare Time Period 1 (ER) with Time Period 2 (IR). Main measure The primary outcome was the percentage in each group reporting a major improvement—defined as a global assessment of sinusitis symptoms as “a lot better” or “no symptoms”—after 3 days of treatment. Key results Major improvement after 3 days was reported during Period 1 by 38.8% of ER HD versus 37.9% of SD patients (P = 0.91) and during Period 2 by 52.4% of IR HD versus 34.4% of SD patients, an effect size of 18% (95% CI 0.75 to 35%, P = 0.04). No significant differences in efficacy were seen at Day 10. The major side effect, severe diarrhea at Day 3, was reported during Period 1 by 7.4% of HD and 5.7% of SD patients (P = 0.66) and during Period 2 by 15.8% of HD and 4.8% of SD patients (P = 0.048). Conclusions Adults with clinically diagnosed acute bacterial sinusitis were more likely to improve rapidly when treated with IR HD than with SD but not when treated with ER HD. They were also more likely to suffer severe diarrhea. Further study is needed to confirm these findings. Trial registration ClinicalTrials.gov Identifier: NCT02340000.
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Affiliation(s)
- Andrea Matho
- Albany Medical Center Hospital, Albany, NY, United States of America
| | - Mary Mulqueen
- Albany Medical Center Hospital, Albany, NY, United States of America
| | - Miyuki Tanino
- Albany Medical Center Hospital, Albany, NY, United States of America
| | - Aaron Quidort
- Albany Medical Center Hospital, Albany, NY, United States of America
| | - Jesse Cheung
- Albany Medical College, Albany, NY, United States of America
| | | | | | - Supraja Swamy
- Albany Medical College, Albany, NY, United States of America
| | - Brittany Tayler
- Albany Medical College, Albany, NY, United States of America
| | - Gina Garrison
- Albany College of Pharmacy and Health Sciences, Albany, NY, United States of America
| | - Ashar Ata
- Department of Surgery, Albany Medical College, Albany, NY, United States of America
| | - Paul Sorum
- Departments of Medicine and Pediatrics, Albany Medical College, Albany, NY, United States of America
- * E-mail:
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Salm F, Schneider S, Schmücker K, Petruschke I, Kramer TS, Hanke R, Schröder C, Heintze C, Schwantes U, Gastmeier P, Gensichen J. Antibiotic prescribing behavior among general practitioners - a questionnaire-based study in Germany. BMC Infect Dis 2018; 18:208. [PMID: 29728063 PMCID: PMC5935909 DOI: 10.1186/s12879-018-3120-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/30/2018] [Indexed: 12/18/2022] Open
Abstract
Background This study investigates the barriers and facilitators of the use of antibiotics in acute respiratory tract infections by general practitioners (GPs) in Germany. Methods A multidisciplinary team designed and pre-tested a written questionnaire addressing the topics awareness of antimicrobial resistance (7 items), use of antibiotics (9 items), guidelines/sources of information (9 items) and sociodemographic factors (7 items), using a five-point-Likert-scale (“never” to “very often”). The questionnaire was mailed by postally to 987 GPs with registered practices in eastern Germany in May 2015. Results 34% (340/987) of the GPs responded to this survey. Most of the participants assumed a multifactorial origin for the rise of multidrug resistant organisms. In addition, 70.2% (239/340) believed that their own prescribing behavior influenced the drug-resistance situation in their area. GPs with longer work experience (> 25 years) assumed less individual influence on drug resistance than their colleagues with less than 7 years experience as practicing physicians (Odds Ratio [OR] 0.32, 95% Confidence Interval [CI] 0.17–0.62; P < 0.001). 99.1% (337/340) of participants were familiar with the “delayed prescription” strategy to reduce antibiotic prescriptions. However, only 29.4% (74/340) answered that they apply it “often” or “very often”. GPs working in rural areas were less likely than those working in urban areas to apply delayed prescription. Conclusion The knowledge on factors causing antimicrobial resistance in bacteria is good among GPs in eastern Germany. However measures to improve rational prescription are not widely implemented yet. Further efforts have to be made in order to improve rational prescription of antibiotic among GPs. Nevertheless, there is a strong awareness of antimicrobial resistance among the participating GPs. Electronic supplementary material The online version of this article (10.1186/s12879-018-3120-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florian Salm
- Institute for Infection Prevention and Hospital Epidemiology, Medical Center - University of Freiburg, Breisacher Str. 115 B, D-79106, Freiburg, Germany. .,Institute of Hygiene and Environmental Medicine, Charité University Medical Center Berlin, German National Reference Center for the Surveillance of Nosocomial Infections, Hindenburgdamm 27, D-12203, Berlin, Germany.
| | - Sandra Schneider
- Institute of Hygiene and Environmental Medicine, Charité University Medical Center Berlin, German National Reference Center for the Surveillance of Nosocomial Infections, Hindenburgdamm 27, D-12203, Berlin, Germany
| | - Katja Schmücker
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, School of Medicine, Bachstrasse 18, D-07743, Jena, Germany
| | - Inga Petruschke
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, School of Medicine, Bachstrasse 18, D-07743, Jena, Germany
| | - Tobias S Kramer
- Institute of Hygiene and Environmental Medicine, Charité University Medical Center Berlin, German National Reference Center for the Surveillance of Nosocomial Infections, Hindenburgdamm 27, D-12203, Berlin, Germany
| | - Regina Hanke
- Institute of Hygiene and Environmental Medicine, Charité University Medical Center Berlin, German National Reference Center for the Surveillance of Nosocomial Infections, Hindenburgdamm 27, D-12203, Berlin, Germany.,Lindgrün GmbH, Cuxhavener Strasse 12, D-10555, Berlin, Germany
| | - Christin Schröder
- Institute of Hygiene and Environmental Medicine, Charité University Medical Center Berlin, German National Reference Center for the Surveillance of Nosocomial Infections, Hindenburgdamm 27, D-12203, Berlin, Germany
| | - Christoph Heintze
- Institute Institute for General Practice and Family Medicine, Charité University Medical Center Berlin, Charitéplatz 1, D-10117, Berlin, Germany
| | - Ulrich Schwantes
- Medizinische Hochschule Brandenburg Theodor Fontane, Fehrbelliner Str. 38, D-16816, Neuruppin, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité University Medical Center Berlin, German National Reference Center for the Surveillance of Nosocomial Infections, Hindenburgdamm 27, D-12203, Berlin, Germany
| | - Jochen Gensichen
- Institute for General Practice, Ludwig-Maxilmilians-University/University Hospital, Pettenkofer str.8/10, D-80336, Munich, Germany
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Jaume F, Quintó L, Alobid I, Mullol J. Overuse of diagnostic tools and medications in acute rhinosinusitis in Spain: a population-based study (the PROSINUS study). BMJ Open 2018; 8:e018788. [PMID: 29391364 PMCID: PMC5878244 DOI: 10.1136/bmjopen-2017-018788] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/16/2017] [Accepted: 11/23/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Acute rhinosinusitis (ARS) has a high incidence. Diagnosis is clinical, and evolution is mostly self-limited. The aim of this study was to describe the sociodemographic characteristics and use of diagnostic tools and medications in patients with ARS. DESIGN This is a prospective observational study in real-life clinical practice. SETTING Patients with clinical diagnosis of ARS (n=2610) were included from ear, nose and throat clinics in Spain. A second visit at resolution was done. PARTICIPANTS Patients were classified according to the duration of symptoms: viral ARS (≤10 days), postviral ARS (>10 days, ≤12 weeks) and chronic rhinosinusitis (>12 weeks). MAIN OUTCOME MEASURES Sociodemographic characteristics, symptoms, disease severity, quality of life (Sino-Nasal Outcome Test-16), used diagnostic tools and medications, and the management performed by primary care physicians (PCPs) and by otorhinolaryngologists (ORLs) were assessed. RESULTS Of the patients 36% were classified as having viral ARS, 63% postviral ARS and 1% as chronic rhinosinusitis. Working in a poorly air-conditioned environment was a risk factor (OR: 2.26, 95% CI 1.27 to 4.04) in developing postviral ARS. A higher number of diagnostic tools (rhinoscopy/endoscopy: 80% vs 70%; plain X-ray: 70% vs 55%; CT scan: 22% vs 12%; P<0.0001) were performed in postviral than viral cases. PCPs performed more X-rays than ORLs (P<0.0001). Patients, more those with postviral than viral ARS, received a high number of medications (oral antibiotics: 76% vs 62%; intranasal corticosteroids: 54% vs 38%; antihistamines: 46% vs 31%; mucolytic: 48% vs 60%; P<0.0001). PCPs prescribed more antibiotics, antihistamines and mucolytics than ORLs (P<0.0068). More patients with postviral than viral ARS reported symptoms of potential complications (1.5% vs 0.4%; P=0.0603). Independently of prescribed medications, quality of life was more affected in patients with postviral (38.7±14.2 vs 36.0±15.3; P=0.0031) than those with viral ARS. ARS resolution was obtained after 6.04 (viral) and 16.55 (postviral) days, with intranasal corticosteroids being associated with longer (OR: 1.07, 95% 1.02 to 1.12) and phytotherapy with shorter (OR: 0.95, 95% CI 0.91 to 1.00) duration. CONCLUSIONS There is a significant overuse of diagnostic tools and prescribed medications, predominantly oral antibiotics, by PCPs and ORLs, for viral and postviral ARS.
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Affiliation(s)
- Francesca Jaume
- Unitat de Rinologia i Clínica de l’Olfacte, Servei d’Otorinolaringologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Immunoal·lèrgia Respiratòria Clínica i Experimental, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Llorenç Quintó
- Institut de Salut Global de Barcelona (ISGlobal) de Recerca en Salut Internacional de Barcelona (CRESIB), Barcelona, Spain
- Centro de Investigación Biomédica En Red en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Isam Alobid
- Unitat de Rinologia i Clínica de l’Olfacte, Servei d’Otorinolaringologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Immunoal·lèrgia Respiratòria Clínica i Experimental, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Joaquim Mullol
- Unitat de Rinologia i Clínica de l’Olfacte, Servei d’Otorinolaringologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Immunoal·lèrgia Respiratòria Clínica i Experimental, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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Ashwood JS, Gaynor M, Setodji CM, Reid RO, Weber E, Mehrotra A. Retail Clinic Visits For Low-Acuity Conditions Increase Utilization And Spending. Health Aff (Millwood) 2017; 35:449-55. [PMID: 26953299 DOI: 10.1377/hlthaff.2015.0995] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Retail clinics have been viewed by policy makers and insurers as a mechanism to decrease health care spending, by substituting less expensive clinic visits for more expensive emergency department or physician office visits. However, retail clinics may actually increase spending if they drive new health care utilization. To assess whether retail clinic visits represent new utilization or a substitute for more expensive care, we used insurance claims data from Aetna for the period 2010-12 to track utilization and spending for eleven low-acuity conditions. We found that 58 percent of retail clinic visits for low-acuity conditions represented new utilization and that retail clinic use was associated with a modest increase in spending, of $14 per person per year. These findings do not support the idea that retail clinics decrease health care spending.
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Affiliation(s)
- J Scott Ashwood
- J. Scott Ashwood is an associate policy researcher at RAND in Santa Monica, California
| | - Martin Gaynor
- Martin Gaynor is the E. J. Barone Professor of Economics and Health Policy and chair of the Governing Board of the Health Care Cost Institute, both at Carnegie Mellon University, in Pittsburgh, Pennsylvania
| | - Claude M Setodji
- Claude M. Setodji is a senior statistician at RAND in Pittsburgh
| | - Rachel O Reid
- Rachel O. Reid is a medical resident in the Department of Medicine, Brigham and Women's Hospital, in Boston, Massachusetts
| | - Ellerie Weber
- Ellerie Weber is an assistant professor of management, policy, and community health at the University of Texas School of Public Health, in Houston
| | - Ateev Mehrotra
- Ateev Mehrotra is an associate professor of health care policy at Harvard Medical School, in Boston
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te Molder M, de Hoog MLA, Uiterwaal CSPM, van der Ent CK, Smit HA, Schilder AGM, Damoiseaux RAMJ, Venekamp RP. Antibiotic Treatment for First Episode of Acute Otitis Media Is Not Associated with Future Recurrences. PLoS One 2016; 11:e0160560. [PMID: 27632355 PMCID: PMC5025241 DOI: 10.1371/journal.pone.0160560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 07/21/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Antibiotic treatment of acute otitis media (AOM) has been suggested to increase the risk of future AOM episodes by causing unfavorable shifts in microbial flora. Because current evidence on this topic is inconclusive and long-term follow-up data are scarce, we wanted to estimate the effect of antibiotic treatment for a first AOM episode occurring during infancy on AOM recurrences and AOM-related health care utilization later in life. METHODS We obtained demographic information and risk factors from data of the Wheezing Illnesses Study Leidsche Rijn, a prospective birth cohort study in which all healthy newborns born in Leidsche Rijn (between 2001 and 2012), The Netherlands, were enrolled. These data were linked to children's primary care electronic health records up to the age of four. Children with at least one family physician-diagnosed AOM episode before the age of two were included in analyses. The exposure of interest was the prescription of oral antibiotics (yes vs no) for a child's first AOM episode before the age of two years. RESULTS 848 children were included in analyses and 512 (60%) children were prescribed antibiotics for their first AOM episode. Antibiotic treatment was not associated with an increased risk of total AOM recurrences (adjusted rate ratio: 0.94, 95% CI: 0.78-1.13), recurrent AOM (≥3 episodes in 6 months or ≥4 in one year; adjusted risk ratio: 0.79, 95% CI: 0.57-1.11), or with increased AOM-related health care utilization during children's first four years of life. CONCLUSIONS Oral antibiotic treatment of a first AOM episode occurring during infancy does not affect the number of AOM recurrences and AOM-related health care utilization later in life. This information can be used when weighing the pros and cons of various AOM treatment options.
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Affiliation(s)
- Marthe te Molder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke L. A. de Hoog
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henriette A. Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne G. M. Schilder
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
- Ear Institute, University College London, London, United Kingdom
| | - Roger A. M. J. Damoiseaux
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roderick P. Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
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18
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Affiliation(s)
- Richard M Rosenfeld
- From the Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn
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19
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Ahovuo‐Saloranta A, Rautakorpi U, Borisenko OV, Liira H, Williams Jr JW, Mäkelä M. WITHDRAWN: Antibiotics for acute maxillary sinusitis in adults. Cochrane Database Syst Rev 2015; 2015:CD000243. [PMID: 26471061 PMCID: PMC10775754 DOI: 10.1002/14651858.cd000243.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Currently, two separate Cochrane reviews, ‘Antibiotics for acute maxillary sinusitis in adults ’ and ‘Antibiotics for clinically diagnosed acute rhinosinusitis in adults ’ describe the effect of antibiotics for acute rhinosinusitis. Although both Cochrane reviews study the same condition, they look at different populations (patients in which the diagnosis was based on clinical signs and symptoms and patients in which the diagnosis was confirmed by imaging). Because of this, the conclusions are different in these Cochrane reviews. This was confusing for clinicians who needed to read both Cochrane reviews to know which conclusions are most applicable to their patients.
This review is being withdrawn and will be incorporated into the updated publication of ‘Antibiotics for clinically diagnosed acute rhinosinusitis in adults ’. This ‘merged’ review will still maintain the relevant distinction between the two populations. However, information on the effectiveness of antibiotics for rhinosinusitis will be published in the ‘merged’ Cochrane review. We will omit the comparison between antibiotics (as published in this Cochrane review) because the choice for certain antibiotics and/or doses differs according to the local antibiotic resistance patterns and therefore this comparison is less relevant. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Anneli Ahovuo‐Saloranta
- National Institute for Health and Welfare (THL)Finnish Office for Health Technology Assessment (FinOHTA)Finn‐Medi 3, Biokatu 10TampereFinlandFI‐33520
| | - Ulla‐Maija Rautakorpi
- National Institute for Health and Welfare (THL), Tampere officeFinnish Office for Health Technology Assessment (FinOHTA)Finn‐Medi 3, Biokatu 10TampereFinlandFI‐33520
| | | | - Helena Liira
- The University of Western AustraliaSchool of Primary, Aboriginal and Rural Health Care35 Stirling HighwayCrawleyWestern AustraliaAustralia6009
| | - John W Williams Jr
- Durham VAMC and Duke University Medical CenterDepartments of Medicine and Psychiatry411 W Chapel Hill St, Suite 500DurhamNCUSA27701
| | - Marjukka Mäkelä
- National Institute for Health and Welfare (THL)Finnish Office for Health Technology Assessment (FinOHTA)PO Box 30HelsinkiFinlandFIN‐00271
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Khalid AN, Ladha KS, Luong AU, Quraishi SA. Association of Vitamin D Status and Acute Rhinosinusitis: Results From the United States National Health and Nutrition Examination Survey 2001-2006. Medicine (Baltimore) 2015; 94:e1447. [PMID: 26447998 PMCID: PMC4616759 DOI: 10.1097/md.0000000000001447] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although vitamin D status may be a modifiable risk factor for various respiratory ailments, limited data exists regarding its role in sinonasal infections. Our goal was to investigate the association of 25-hydroxyvitamin D (25OHD) levels with acute rhinosinusitis (ARS) in a large, nationally representative sample of non-institutionalized individuals from the United States. In this cross-sectional study of individuals ≥ 17 years from the National Health and Nutrition Examination Survey 2001-2006, we used multivariable regression analysis to investigate the association of 25OHD levels with ARS, while adjusting for season, demographics (age, sex, race, and poverty-to-income ratio), and clinical data (smoking, asthma, chronic obstructive pulmonary disease, diabetes mellitus, and neutropenia). A total of 3921 individuals were included in our analyses. Median 25OHD level was 22 (interquartile range 16-28) ng/mL. Overall, 15.8% (95% confidence interval [CI] 14.4-17.7) of participants reported ARS within the 24 hours leading up to their survey participation. After adjusting for season, demographics, and clinical data, 25OHD levels were associated with ARS (odds ratio 0.88, 95% CI 0.78-0.99 per 10 ng/mL). When vitamin D status was dichotomized, 25OHD levels < 20 ng/mL were associated with 33% higher odds of ARS (odds ratio 1.33, 95% CI 1.03-1.72) compared with levels ≥ 20 ng/mL. Our analyses suggest that 25OHD levels are inversely associated with ARS. Randomized, controlled trials are warranted to determine the effect of optimizing vitamin D status on the risk of sinonasal infections.
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Affiliation(s)
- Ayesha N Khalid
- From the Department of Surgery (ANK), Division of Otolaryngology-Head and Neck Surgery, Cambridge Hospital, Cambridge, MA; Department of Laryngology and Otology (ANK), Harvard Medical School; Department of Otolaryngology-Head and Neck Surgery (ANK), Boston University Medical Center; Department of Anesthesia, Critical Care and Pain Medicine (KSL, SAQ), Massachusetts General Hospital; Department of Anaesthesia (KSL, SAQ), Harvard Medical School, Boston, MA; and Department of Otorhinolaryngology-Head and Neck Surgery (AUL), University of Texas Medical School at Houston, Houston, TX
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Pynnonen MA, Lynn S, Kern HE, Novis SJ, Akkina SR, Keshavarzi NR, Davis MM. Diagnosis and treatment of acute sinusitis in the primary care setting: A retrospective cohort. Laryngoscope 2015. [DOI: https:/doi-org.ezproxy.lib.utexas.edu/10.1002/lary.25363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
| | | | | | | | | | | | - Matthew M. Davis
- Department of Pediatrics and Communicable DiseasesDepartment of Internal MedicineUniversity of Michigan Medical School; Gerald R. Ford School of Public Policy, University of MichiganAnn Arbor Michigan U.S.A
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Pynnonen MA, Lynn S, Kern HE, Novis SJ, Akkina SR, Keshavarzi NR, Davis MM. Diagnosis and treatment of acute sinusitis in the primary care setting: A retrospective cohort. Laryngoscope 2015; 125:2266-72. [PMID: 26010534 DOI: 10.1002/lary.25363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES AND HYPOTHESIS Our objectives were to characterize the quality of acute sinusitis care and to identify nonclinical factors associated with antibiotic use for acute sinusitis. We hypothesized that we would identify provider-level factors associated with antibiotic use. STUDY DESIGN Retrospective cohort at a single academic institution. METHODS We developed and clinically annotated an administrative dataset of adult patients diagnosed with acute sinusitis between January 1, 2005, and December 31, 2006. We used identify factors associated with receipt of antibiotics. RESULTS We find that 66.0% of patients with mild symptoms of short duration are given antibiotics, and that nonclinical factors, including the individual provider, the provider's specialty, and the presence of a medical trainee, significantly influence antibiotic use. Relative to internal medicine providers, family medicine providers use fewer antibiotics, and emergency medicine providers use more antibiotics for acute sinusitis. CONCLUSIONS Antibiotics continue to be overused for patients with mild acute sinusitis of short duration. Nonclinical characteristics, including the individual provider, the provider's specialty, and the presence of a medical trainee, significantly influence use of antibiotics for acute sinusitis. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | | | | | | | | | | | - Matthew M Davis
- Department of Pediatrics and Communicable Diseases, Department of Internal Medicine, University of Michigan Medical School; Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan, U.S.A
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Comparative study of the efficacy of topical steroid and antibiotic combination therapy versus oral antibiotic alone when treating acute rhinosinusitis. The Journal of Laryngology & Otology 2015; 129:462-7. [DOI: 10.1017/s0022215115000456] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Acute rhinosinusitis arises as a consequence of viral rhinitis, and bacterial infection can subsequently occur. Intranasal antibiotics as an adjunct to corticosteroids usually demonstrate the greatest symptom relief.Aim:We wanted to clinically evaluate the effects of a topical antibiotic and steroid combination administered intranasally, versus an oral antibiotic alone when treating acute rhinosinusitis.Method:Forty patients with acute bacterial rhinosinusitis were divided into two groups. Group A received an antibiotic and steroid combination (ofloxacin 0.26 per cent and dexamethasone 0.053 per cent nasal drops) for 10 days, administered intranasally (5 drops in each nostril/8 hours). Group B, the control group, received an oral antibiotic alone (amoxicillin 90 mg/kg).Results:Eight hours after commencing treatment, facial pain was more severe in group B and nasal obstruction was reduced in both groups. Ten days after commencing treatment, anterior nasal discharge was 0.15 per cent in group A and absent in group B.Conclusion:The application of a topical antibiotic and steroid combination into the nasal cavity is an effective way of treating uncomplicated, acute bacterial rhinosinusitis with the theoretical advantages of easy administration, high local drug concentration and minimal systemic adverse effects.
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Antibiotic efficacy in patients with a moderate probability of acute rhinosinusitis: a systematic review. Eur Arch Otorhinolaryngol 2015; 273:1067-77. [DOI: 10.1007/s00405-015-3506-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
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Khoshdel A, Panahande GR, Noorbakhsh MK, Malek Ahmadi MR, Lotfizadeh M, Parvin N. A comparison of the efficacy of amoxicillin and nasal irrigation in treatment of acute sinusitis in children. KOREAN JOURNAL OF PEDIATRICS 2014; 57:479-83. [PMID: 25550702 PMCID: PMC4279008 DOI: 10.3345/kjp.2014.57.11.479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 02/19/2014] [Accepted: 07/01/2014] [Indexed: 11/27/2022]
Abstract
Purpose The efficacy of antibiotic therapy for acute sinusitis is controversial. This study aimed to compare the efficacies of amoxicillin with nasal irrigation and nasal irrigation alone for acute sinusitis in children. Methods This randomized, double-blind, controlled study included 80 children aged 4-15 years with a clinical presentation of acute sinusitis. Patients were randomly assigned to receive either amoxicillin (80 mg/kg/day) in 3 divided doses orally for 14 days with saline nasal irrigation (for 5 days) and 0.25% phenylephrine (for 2 days) or the same treatment without amoxicillin. Clinical improvements in their initial symptoms were assessed on days 3, 14, 21, and 28. Results On day 3, patients in the amoxicillin with nasal irrigation group showed significant clinical improvement (P=0.001), but there was no significant difference in the degree of improvement between the amoxicillin with nasal irrigation and nasal irrigation alone groups during follow-up (P>0.05). In addition, no significant differences were seen in age, sex, and degree of improvement between groups (P>0.05). Conclusion High-dose amoxicillin with saline nasal irrigation relieved acute sinusitis symptoms faster and more often than saline nasal irrigation alone. However, antibiotic treatment for acute sinusitis confers only a small therapeutic benefit over nasal irrigation.
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Affiliation(s)
- Abolfazl Khoshdel
- Biochemistry Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | | | | | | | - Masoud Lotfizadeh
- Community Health Department, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Neda Parvin
- Nursing Department, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Smith SS, Ference EH, Evans CT, Tan BK, Kern RC, Chandra RK. The prevalence of bacterial infection in acute rhinosinusitis: a Systematic review and meta-analysis. Laryngoscope 2014; 125:57-69. [PMID: 24723427 DOI: 10.1002/lary.24709] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/24/2014] [Accepted: 04/07/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVES/HYPOTHESIS To systematically assess the prevalence of bacterial infection in adults with acute rhinosinusitis (ARS). METHODS Electronic databases were systematically searched for relevant studies published up to June 2012. RESULTS Twenty-nine articles, evaluating a total of 9,595 patients with a clinical diagnosis of ARS, were included in the study. Of these, 14 (48%) studies required radiographic confirmation of sinusitis, one study (3%) required evidence of purulence, 10 studies (35%) required both for inclusion in the study population, and four studies (14%) required neither. The random effects model estimate of prevalence of bacterial growth on all cultures was 53.7% (CI 48.4%-59.0%), ranging from 52.5% (CI 46.7%-58.3%) in studies requiring radiographic confirmation of sinusitis to 61.1% (CI 54.0%-68.1%) in studies requiring neither radiographic evidence nor purulence on exam. Studies that obtained cultures from antral swab had a prevalence of bacterial growth of 61.0% (CI 54.7%-67.2%), whereas those utilizing endoscopic meatal sampling had a prevalence of 32.9% (CI 19.0%-46.8%). CONCLUSIONS Few studies evaluate the recovery of bacteria via culture in adults with a diagnosis of ABRS or ARS based on clinical criteria alone. With radiographic and/or endoscopic confirmation, antral puncture and endoscopically guided cultures produce positive bacterial cultures in approximately one-half of patients. Opportunities exist to improve diagnostic accuracy for bacterial infection in ARS.
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Affiliation(s)
- Stephanie S Smith
- Department of Otolaryngology-Head and Neck Surgery, Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago; Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago
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Llor C, Monedero MJ, García G, Arranz J, Cots JM, Bjerrum L. Interventions to improve adherence to first-line antibiotics in respiratory tract infections. The impact depends on the intensity of the intervention. Eur J Gen Pract 2014; 21:12-8. [DOI: 10.3109/13814788.2014.933205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Trends and seasonal variation in outpatient antibiotic prescription rates in the United States, 2006 to 2010. Antimicrob Agents Chemother 2014; 58:2763-6. [PMID: 24590486 DOI: 10.1128/aac.02239-13] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antibiotic-resistant bacteria are an increasing threat to the effectiveness of antibiotics. The majority of antibiotics are prescribed in primary care settings for upper respiratory tract infections. The purpose of this study was to describe seasonal trends in outpatient antibiotic prescriptions (Rx) in the United States over a 5-year period. This study was a retrospective, cross-sectional observation of systemic antibiotic prescriptions in the outpatient setting from 2006 to 2010. Winter months were defined as the first and fourth quarters of the calendar year. Antibiotic prescribing rates were calculated (prescriptions/1,000 population) using annual U.S. Census Bureau population data. Over 1.34 billion antibiotic prescriptions were dispensed over the 5-year period. The antibiotic prescription (Rx) rate decreased from 892 Rx/1,000 population in 2006 to 867 Rx/1,000 population in 2010. Penicillins and macrolides were the primary antibiotic classes prescribed, but penicillin prescribing decreased while macrolide prescribing increased over the study period. Overall, antibiotic prescriptions were 24.5% higher in winter months than in the summer, with the largest difference (28.8%) in 2008 and the smallest (20.4%) in 2010. This seasonality was consistently drug class dependent, driven by 75% and 100% increases in penicillin and macrolide prescriptions, respectively, in the winter months. The mean outpatient antibiotic prescription rate decreased in the United States from 2006 to 2010. More antibiotic prescribing, predominately driven by the macrolide and penicillin classes, in the outpatient setting was observed in the winter months. Understanding annual variability in antibiotic use can assist with designing interventions to improve the judicious use of antibiotics.
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Kaplan A. Canadian guidelines for acute bacterial rhinosinusitis: clinical summary. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2014; 60:227-34. [PMID: 24627376 PMCID: PMC3952756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To provide a clinical summary of the Canadian clinical practice guidelines for acute bacterial rhinosinusitis (ABRS) that includes relevant considerations for family physicians. QUALITY OF EVIDENCE Guideline authors performed a systematic literature search and drafted recommendations. Recommendations received both strength of evidence and strength of recommendation ratings. Input from external content experts was sought, as was endorsement from Canadian medical societies (Association of Medical Microbiology and Infectious Disease Canada, Canadian Society of Allergy and Clinical Immunology, Canadian Society of Otolaryngology-Head and Neck Surgery, Canadian Association of Emergency Physicians, and the Family Physicians Airways Group of Canada). MAIN MESSAGE Diagnosis of ABRS is based on the presence of specific symptoms and their duration; imaging or culture are not needed in uncomplicated cases. Treatment is dependent on symptom severity, with intranasal corticosteroids (INCSs) recommended as monotherapy for mild and moderate cases, although the benefit might be modest. Use of INCSs plus antibiotics is reserved for patients who fail to respond to INCSs after 72 hours, and for initial treatment of patients with severe symptoms. Antibiotic selection must account for the suspected pathogen, the risk of resistance, comorbid conditions, and local antimicrobial resistance trends. Adjunct therapies such as nasal saline irrigation are recommended. Failure to respond to treatment, recurrent episodes, and signs of complications should prompt referral to an otolaryngologist. The guidelines address situations unique to the Canadian health care environment, including actions to take during prolonged wait periods for specialist referral or imaging. CONCLUSION The Canadian guidelines provide up-to-date recommendations for diagnosis and treatment of ABRS that reflect an evolving understanding of the disease. In addition, the guidelines offer useful tools to help clinicians discern viral from bacterial episodes, as well as optimally manage their patients with ABRS.
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Affiliation(s)
- Alan Kaplan
- 17 Bedford Park Ave, Richmond Hill, ON L4C 2N9.
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Ahovuo-Saloranta A, Rautakorpi UM, Borisenko OV, Liira H, Williams JW, Mäkelä M. Antibiotics for acute maxillary sinusitis in adults. Cochrane Database Syst Rev 2014:CD000243. [PMID: 24515610 DOI: 10.1002/14651858.cd000243.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sinusitis is one of the most common diagnoses among adults in ambulatory care, accounting for 15% to 21% of all adult outpatient antibiotic prescriptions. However, the role of antibiotics for sinusitis is controversial. OBJECTIVES To assess the effects of antibiotics in adults with acute maxillary sinusitis by comparing antibiotics with placebo, antibiotics from different classes and the side effects of different treatments. SEARCH METHODS We searched CENTRAL 2013, Issue 2, MEDLINE (1946 to March week 3, 2013), EMBASE (1974 to March 2013), SIGLE (OpenSIGLE, later OpenGrey (accessed 15 January 2013)), reference lists of the identified trials and systematic reviews of placebo-controlled studies. We also searched for ongoing trials via ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). We imposed no language or publication restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing antibiotics with placebo or antibiotics from different classes for acute maxillary sinusitis in adults. We included trials with clinically diagnosed acute sinusitis, confirmed or not by imaging or bacterial culture. DATA COLLECTION AND ANALYSIS Two review authors independently screened search results, extracted data and assessed trial quality. We calculated risk ratios (RRs) for differences between intervention and control groups in whether the treatment failed or not. All measures are presented with 95% confidence intervals (CIs). We conducted the meta-analyses using either the fixed-effect or random-effects model. In meta-analyses of the placebo-controlled studies, we combined data across antibiotic classes. Primary outcomes were clinical failure rates at 7 to 15 days and 16 to 60 days follow-up. We used GRADEpro to assess the quality of the evidence. MAIN RESULTS We included 63 studies in this updated review; nine placebo-controlled studies involving 1915 participants (seven of the studies clearly conducted in primary care settings) and 54 studies comparing different classes of antibiotics (10 different comparisons). Five studies at low risk of bias comparing penicillin or amoxicillin to placebo provided information on the main outcome: clinical failure rate at 7 to 15 days follow-up, defined as a lack of full recovery or improvement, for participants with symptoms lasting at least seven days. In these studies antibiotics decreased the risk of clinical failure (pooled RR of 0.66, 95% CI 0.47 to 0.94, 1084 participants randomised, 1058 evaluated, moderate quality evidence). However, the clinical benefit was small. Cure or improvement rates were high in both the placebo group (86%) and the antibiotic group (91%) in these five studies. When clinical failure was defined as a lack of full recovery (n = five studies), results were similar: antibiotics decreased the risk of failure (pooled RR of 0.73, 95% CI 0.63 to 0.85, high quality evidence) at 7 to 15 days follow-up.Adverse effects in seven of the nine placebo-controlled studies (comparing penicillin, amoxicillin, azithromycin or moxicillin to placebo) were more common in antibiotic than in placebo groups (median of difference between groups 10.5%, range 2% to 23%). However, drop-outs due to adverse effects were rare in both groups: 1.5% in antibiotic groups and 1% in control groups.In the 10 head-to-head comparisons, none of the antibiotic preparations were superior to another. However, amoxicillin-clavulanate had significantly more drop-outs due to adverse effects than cephalosporins and macrolides. AUTHORS' CONCLUSIONS There is moderate evidence that antibiotics provide a small benefit for clinical outcomes in immunocompetent primary care patients with uncomplicated acute sinusitis. However, about 80% of participants treated without antibiotics improved within two weeks. Clinicians need to weigh the small benefits of antibiotic treatment against the potential for adverse effects at both the individual and general population levels.
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Affiliation(s)
- Anneli Ahovuo-Saloranta
- Finnish Office for Health Technology Assessment (FinOHTA), National Institute for Health and Welfare (THL), Tampere office, Finn-Medi 3, Biokatu 10, Tampere, Finland, FI-33520
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Tashima L, Piccirillo JF. Are antibiotics indicated for acute sinusitis? Laryngoscope 2014; 124:1979-80. [DOI: 10.1002/lary.24540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/11/2013] [Accepted: 11/25/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Lauren Tashima
- Department of Otolaryngology-Head and Neck Surgery; Washington University in St. Louis; St. Louis Missouri U.S.A
| | - Jay F. Piccirillo
- Department of Otolaryngology-Head and Neck Surgery; Washington University in St. Louis; St. Louis Missouri U.S.A
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Medical Management of Acute Rhinosinusitis in Children and Adults. DISEASES OF THE SINUSES 2014. [PMCID: PMC7122618 DOI: 10.1007/978-1-4939-0265-1_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Bacteria can be recovered from paranasal sinuses in the majority of patients given the diagnosis of acute bacterial sinusitis (ABS), and bacteriologic cure can be achieved with appropriate antibiotic treatment. The critical question is whether bacteriologic cure correlates with meaningful clinical endpoints such as clinical improvement, reduction in recurrent disease, or prevention of complications. Of the 4 pediatric placebo-controlled randomized clinical trials (PCRCTs), 2 suggest superiority of antibiotic treatment and 2 suggest lack of superiority. PCRCTs in adults are mixed as to clinical benefit. Pediatric and adult meta-analyses demonstrate modest benefit of antibiotic therapy and rates of spontaneous recovery without antibiotics of 60-65%. Although retrospective studies indicate that some patients who develop orbital or neurologic complications of sinusitis were pre-treated with antibiotic therapy, a low rate of complications precludes determination of whether antibiotic treatment prevents complications in some proportion of patients. Like the literature evidence, expert guideline recommendations are mixed. Although the evidence base is incomplete and conflicting, the limited data suggest that antibiotics probably do have a role in the treatment of pediatric ABS. The most compelling rationale is prevention of serious complications, but proof for this rationale is lacking.
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Mollahaliloglu S, Alkan A, Donertas B, Ozgulcu S, Akici A. Assessment of antibiotic prescribing at different hospitals and primary health care facilities. Saudi Pharm J 2013; 21:281-91. [PMID: 23960845 PMCID: PMC3745021 DOI: 10.1016/j.jsps.2012.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 10/28/2012] [Indexed: 10/27/2022] Open
Abstract
In this study, it was aimed to investigate the utilization of antibiotics at various health care facilities. Photocopies of 1250 prescriptions which were containing antibiotics and written out in primary health care facilities (PHCFs), public hospitals (PHs), private hospitals and university hospitals in 10 provinces across Turkey, were evaluated by some drug use indicators. The number of drugs per prescription was 3.23 ± 0.92 and it was highest in PHCFs (3.34 ± 0.84), (p < 0.05). The cost per prescription was 33.3 $, being highest in PHs while being lowest in PHCFs (38.6 $ and 28.2 $ respectively). Antibiotic cost per prescription was 16.7 $ and it was also highest and lowest in PHs and PHCFs respectively (p < 0.05). The most commonly prescribed group of antibiotics was "beta-lactam antibacterials, penicillins" (29.2%) while amoxicillin/clavulanic acid was the most commonly prescribed antibiotic (18.1%). Sixty-one percent of the antibiotics prescribed for acute infections was generics; among facilities being highest in PHCFs (66.5%) and among diagnosis being highest in acute pharyngitis. In general, the duration of antibiotic therapy was approximately 7 days for acute infections. Although much more drugs were prescribed in PHCFs than others, it was found to be in an inverse proportion with both the total cost of prescriptions and the cost of antibiotics. Broad-spectrum antibiotics, beta-lactamase combinations in particular, were considered to be more preferable in all health care facilities is also notable. These results do serve as a guide to achieve the rational use of antibiotics on the basis of health care facilities and indications.
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Affiliation(s)
| | - Ali Alkan
- Turkish Ministry of Health, RSHCP, School of Public Health, Ankara, Turkey
| | - Basak Donertas
- Marmara University School of Medicine, Department of Pharmacology, Istanbul, Turkey
| | - Senay Ozgulcu
- Turkish Ministry of Health, RSHCP, School of Public Health, Ankara, Turkey
| | - Ahmet Akici
- Marmara University School of Medicine, Department of Pharmacology, Istanbul, Turkey
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Eichel A, Wittig J, Shah-Hosseini K, Mösges R. A prospective, controlled study of SNS01 (ectoine nasal spray) compared to BNO-101 (phytotherapeutic dragées) in patients with acute rhinosinusitis. Curr Med Res Opin 2013; 29:739-46. [PMID: 23621514 DOI: 10.1185/03007995.2013.800474] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In this observational study, data on the efficacy, effects on quality of life and tolerability of the topical formulation SNS01 (Ectoin Rhinitis nasal spray) were compared to those of BNO-101 (Sinupret forte dragées) in patients with acute rhinosinusitis in the ear, nose, and throat (ENT) clinical setting. DESIGN AND METHODS Patients with the diagnosis of acute rhinosinusitis were included in this non-interventional study with a treatment duration of 14-16 days. They received either a herbal phytotherapeutic dragée (control) or an ectoine-based nasal spray (investigational product), each to be taken according to the instructions for use (IFU) and summary of product characteristics (SPC). At each visit, the physician performed a nasal endoscopy, recorded the Sinusitis Symptom Score and checked for adverse events. During the entire treatment period, patients recorded the Sinusitis Symptom Score in patient diaries. In addition, patients receiving the nasal spray filled out a questionnaire to assess the tolerability of the treatment. To investigate effects on quality of life patients were asked to fill out the German version of a sinusitis-specific HRQL (health related quality of life) questionnaire. CLINICAL TRIAL REGISTRATION NCT01684540. RESULTS Patient diary entries, the assessment of the Sinusitis Symptom Score and the HRQL questionnaire demonstrated that the ectoine nasal spray was as effective as the phytotherapeutic dragées in treating acute rhinosinusitis. After two weeks of treatment, the assessments of both the patients' diaries and physicians' record forms indicated statistically significant improvement (p ≤ 0.001) in the symptom scores of the two groups (57.8% improvement for ectoine and 49.3% improvement for the phytotherapeutic dragées compared to baseline). Also, overall scores of 80 in the sensory questionnaire confirmed the good tolerability of the nasal spray. Correspondingly, HRQL improved significantly over the course of the treatment in both groups. CONCLUSION SNS01 and BNO-101 demonstrated comparable effects in the treatment of acute rhinosinusitis. LIMITATIONS Following German regulations, this trial was set up as an observational 'non-interventional' study, which does not allow for a placebo group or randomization of patients. Although the grade of evidence delivered by the study data is thus reduced from Ib to IIa, it does, however, reflect a realistic view of the most common clinical practice.
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Affiliation(s)
- Andrea Eichel
- Institute of Medical Statistics, Informatics and Epidemiology, Faculty of Medicine, University of Cologne, Cologne, Germany.
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Jørgensen LC, Friis Christensen S, Cordoba Currea G, Llor C, Bjerrum L. Antibiotic prescribing in patients with acute rhinosinusitis is not in agreement with European recommendations. Scand J Prim Health Care 2013; 31:101-5. [PMID: 23659709 PMCID: PMC3656392 DOI: 10.3109/02813432.2013.788270] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the potential overprescribing in patients with acute rhinosinusitis across six countries with different antibiotic prescribing rates and different prevalence of antibiotic resistance. DESIGN, SETTING AND SUBJECTS A cross-sectional study including GPs from two Nordic countries, two Baltic countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) during three weeks in January 2008 as part of the EU-funded project "Health Alliance for Prudent Prescribing, Yield And Use of antimicrobial Drugs In the Treatment of respiratory tract infections" (HAPPY AUDIT). MAIN OUTCOME MEASURES Use of antibiotics for acute rhinosinusitis based on the recommendations in the European Position Paper on Rhinosinusitis and Nasal Polyps 2007 (EP3OS). RESULTS In total, 618 participating GPs registered 33 273 patients with RTI of whom 1150 (3.46%) were considered to have acute rhinosinusitis. Over 50% of the patients with acute rhinosinusitis had symptoms for < 5 days and 81% were prescribed antibiotics. In total, 68% of the patients included were not prescribed antibiotics according to guidelines; 45% had symptoms < 5 days or no fever (possible overprescribing) and 23% had symptoms < 5 days and no fever (probable overprescribing). CONCLUSION A considerable number of patients with symptoms of acute rhinosinusitis were not managed according to European recommendations (EP3OS guidelines). To prevent overprescribing, efforts should be made to implement the recommendations in daily practice.
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Affiliation(s)
- Lars Christian Jørgensen
- Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Smith SS, Kern RC, Chandra RK, Tan BK, Evans CT. Variations in antibiotic prescribing of acute rhinosinusitis in United States ambulatory settings. Otolaryngol Head Neck Surg 2013; 148:852-9. [PMID: 23462657 PMCID: PMC5514556 DOI: 10.1177/0194599813479768] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 01/31/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify variations in antibiotic treatment of acute rhinosinusitis (ARS) on a national level. STUDY DESIGN Cross-sectional study of a national database. SETTING Otolaryngology and primary care ambulatory settings. SUBJECTS AND METHODS A nationally representative sample of adult outpatient visits was extracted from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey data for 2006 to 2009. Antibiotic prescriptions associated with ARS were tabulated. Statistical analyses were conducted to identify variations in antibiotic prescribing by patient and physician characteristics. RESULTS Antibiotics were prescribed in 82.3% ± 2.6% of 18.7 million visits for ARS (mean age, 46.2 years; 65.9% female). The ratio of primary care physician (PCP) to otolaryngologist (ENT) ARS visits was 18.6:1. Antibiotic prescription rates were inversely related to increasing age groups of 18 to 39, 40 to 64, and ≥ 65 years (87.8%, 81.2%, and 71.0%, respectively; P = .02). Physicians in general medicine outpatient departments, internal medicine, and family medicine were more likely to prescribe antibiotics compared with ENTs (adjusted odds ratio [OR], 7.9 [95% confidence interval (CI), 3.5-17.8]; 6.9 [2.5-19.2]; and 3.9 [2.0-7.7], respectively). The most commonly prescribed antibiotics were azithromycin, amoxicillin, and amoxicillin/clavulanate acid (27.5%, 15.5%, and 14.6%, respectively). The ENTs selected broad-spectrum antibiotics more often than PCPs (94.3% vs 75.7% of visits with antibiotics were broad-spectrum agents; P = .01). CONCLUSION Antibiotics were prescribed frequently despite recent consensus guidelines that discourage antibiotic use in mild cases. Furthermore, antibiotic prescription was more likely for younger patients and in primary care settings. This highlights the need to promote awareness of practice guidelines.
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Affiliation(s)
- Stephanie Shintani Smith
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Suda KJ, Hicks LA, Roberts RM, Hunkler RJ, Danziger LH. A national evaluation of antibiotic expenditures by healthcare setting in the United States, 2009. J Antimicrob Chemother 2012; 68:715-8. [DOI: 10.1093/jac/dks445] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Lee S, Woodbury K, Ferguson BJ. Use of nasopharyngeal culture to determine appropriateness of antibiotic therapy in acute bacterial rhinosinusitis. Int Forum Allergy Rhinol 2012; 3:272-5. [PMID: 23109504 DOI: 10.1002/alr.21102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 07/31/2012] [Accepted: 08/14/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND Rhinosinusitis is one of the top 5 diagnoses for which an antibiotic is prescribed, often without a clear bacterial etiology. This study evaluated whether nasopharyngeal culture and gram stain could serve as a surrogate for endoscopically obtained middle meatal cultures in directing appropriate therapy for acute bacterial rhinosinusitis (ABRS). This study also investigated the utility of a rapid sinus test screen in differentiating bacterial from nonbacterial rhinosinusitis. METHODS Thirty-one adult patients met inclusion criteria for ABRS. Samples were obtained from both the middle meatus and nasopharynx for Gram stain and culture. Nasal mucous samples were tested with a rapid sinus test strip measuring pH, levels of protein, nitrites, and leukocyte esterase. RESULTS Sixty-one percent (61%) of nasopharyngeal and 48% of middle meatal samples grew pathogenic bacteria. The concordance rate was 84% between the 2 sites (p = 0.0006). The following pathogenic organisms were detected: Moraxella catarrhalis, Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, and Staphylococcus aureus. For nasopharyngeal samples, reliance on Gram stain alone exhibited a sensitivity of 31% and specificity of 100% and, similarly, for middle meatus samples, 47% and 93%, respectively. The rapid sinus test revealed a sensitivity of 83% and specificity of 7%. CONCLUSION Nasopharyngeal and middle meatal cultures exhibited high concordance for pathogenic bacteria. Gram stain exhibited moderate sensitivity and excellent specificity. Nasopharyngeal cultures could provide a viable method, especially in a primary care setting, for determining the appropriateness of antibiotic therapy. The rapid sinus test's lack of specificity precluded its utility in the differentiation between bacterial and nonbacterial rhinosinusitis.
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Affiliation(s)
- Stella Lee
- Division of Sinonasal Disorders and Allergy, University of Pittsburgh Medical Center, Pittsburgh, PA 15219, USA.
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Lemiengre MB, van Driel ML, Merenstein D, Young J, De Sutter AIM. Antibiotics for clinically diagnosed acute rhinosinusitis in adults. Cochrane Database Syst Rev 2012; 10:CD006089. [PMID: 23076918 DOI: 10.1002/14651858.cd006089.pub4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In primary care settings, the diagnosis of rhinosinusitis is generally based on clinical signs and symptoms. Technical investigations are not routinely performed, nor recommended. Individual trials show a trend in favour of antibiotics, but the balance of benefit versus harm is unclear. OBJECTIVES To assess the effect of antibiotics in adults with clinically diagnosed rhinosinusitis in primary care settings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2012), MEDLINE (January 1950 to February week 4, 2012) and EMBASE (January 1974 to February 2012). SELECTION CRITERIA Randomised controlled trials (RCTs) of antibiotics versus placebo in participants with rhinosinusitis-like signs or symptoms. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed the risk of bias. We contacted trial authors for additional information. We collected information on adverse effects from the trials. MAIN RESULTS We included 10 trials involving 2450 participants. Overall, the risk of bias in these studies was low. Irrespective of the treatment group, 47% of participants were cured after one week and 71% after 14 days. Antibiotics can shorten the time to cure, but only five more participants per 100 will cure faster at any time point between 7 and 14 days if they receive antibiotics instead of placebo (number needed to treat to benefit (NNTB)) 18 (95% confidence interval (CI) 10 to 115, I(2) statistic 0%, eight trials). Purulent secretion resolves faster with antibiotics (odds ratio (OR) 1.58 (95% CI 1.13 to 2.22)), (NNTB 11, 95% CI 6 to 51, I(2) statistic 0%, three trials). However, 27% of the participants who received antibiotics and 15% of those who received placebo experienced adverse events (OR 2.10, 95% CI 1.60 to 2.77) (number needed to treat to harm (NNTH)) 8 (95% CI 6 to 13, I(2) statistic 13%, seven trials). More participants in the placebo group needed to start antibiotic therapy because of an abnormal course of rhinosinusitis (OR 0.49, 95% CI 0.36 to 0.66), NNTH 20 (95% CI 14 to 35, I(2) statistic 0%, eight trials). Only one disease-related complication (brain abscess) occurred in a patient treated with antibiotics. AUTHORS' CONCLUSIONS The potential benefit of antibiotics in the treatment of clinically diagnosed acute rhinosinusitis needs to be seen in the context of a high prevalence of adverse events. Taking into account antibiotic resistance and the very low incidence of serious complications, we conclude that there is no place for antibiotics for the patient with clinically diagnosed, uncomplicated acute rhinosinusitis. This review cannot make recommendations for children, patients with a suppressed immune system and patients with severe disease, as these populations were not included in the available trials.
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Affiliation(s)
- Marieke B Lemiengre
- Department of General Practice and Primary Health Care, Ghent University, Ghent, Belgium.
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Boisselle C, Rowland K. PURLs: Rethinking antibiotics for sinusitis: again. THE JOURNAL OF FAMILY PRACTICE 2012; 61:610-612. [PMID: 23106063 PMCID: PMC3601684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Previous evidence rejected the need for antibiotics to treat acute rhinosinusitis, unless the symptoms were severe. A new study finds little reason to prescribe them even then.
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Takhar SS, Schriger DL, Barrett TW. Some Think Antibiotics Are Candy, But We Know They're Not. Ann Emerg Med 2012; 60:528-34. [DOI: 10.1016/j.annemergmed.2012.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Chapa D, Hartung MK, Mayberry LJ, Pintz C. Using preappraised evidence sources to guide practice decisions. J Am Assoc Nurse Pract 2012; 25:234-43. [DOI: 10.1111/j.1745-7599.2012.00787.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Deborah Chapa
- School of Nursing, The George Washington University; Washington; DC
| | | | | | - Christine Pintz
- School of Nursing, The George Washington University; Washington; DC
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Eichner ER. Research news impacting sports medicine: food for thought or fun to learn. Curr Sports Med Rep 2012; 11:218-9. [PMID: 22965341 DOI: 10.1249/jsr.0b013e31826a3adc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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McIlraith I. F.Y.Eye. Can J Ophthalmol 2012. [DOI: 10.1016/j.jcjo.2012.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Takhar SS, Schriger DL, Barrett TW. Some Think Antibiotics are Candy, But We Know They're Not. Ann Emerg Med 2012; 59:440-1. [DOI: 10.1016/j.annemergmed.2012.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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