Effect of Ceftriaxone versus Amoxicillin + Clavulanic Acid for Treatment of Acute Bacterial Rhino Sinusitis: Short Course Therapy

Variation in Antibiotic Treatment Failure Outcome Definitions in Randomised Trials and Observational Studies of Antibiotic Prescribing Strategies: A Systematic Review and Narrative Synthesis

Antibiotic treatment failure is used as an outcome in randomised trials and observational studies of antibiotic treatment strategies and may comprise different events that indicate failure to achieve a desired clinical response. However, the lack of a universally recognised definition has led to considerable variation in the types of events included. We undertook a systematic review of published studies investigating antibiotic treatment strategies for common uncomplicated infections, aiming to describe variation in terminology and components of the antibiotic treatment failure outcomes. We searched Medline, Embase, and the Cochrane Central Register of Clinical trials for English language studies published between January 2010 and January 2021. The population of interest was ambulatory patients seen in primary care or outpatient settings with respiratory tract (RTI), urinary tract (UTI), or skin and soft tissue infection (SSTI), where different antibiotic prescribing strategies were compared, and the outcome was antibiotic treatment failure. We narratively summarised key features from eligible studies and used frequencies and proportions to describe terminology, components, and time periods used to ascertain antibiotic treatment failure outcomes. Database searches identified 2967 unique records, from which 36 studies met our inclusion criteria. This included 10 randomised controlled trials and 26 observational studies, with 20 studies of RTI, 12 of UTI, 4 of SSTI, and 2 of both RTI and SSTI. We identified three key components of treatment failure definitions: prescription changes, escalation of care, and change in clinical condition. Prescription changes were most popular in studies of UTI, while changes in clinical condition were most common in RTI and SSTI studies. We found substantial variation in the definition of antibiotic treatment failure in included studies, even amongst studies of the same infection subtype and study design. Considerable further work is needed to develop a standardised definition of antibiotic treatment failure in partnership with patients, clinicians, and relevant stakeholders.

Effects of different antibiotics in the treatment of acute rhinosinusitis

Introduction: Sinusitis is an inflammation of the paranasal sinuses and it can be infectious, allergic or autoimmune. Acute rhinosinusitis commonly has viral origin and occurs as part of the upper respiratory tract infections. The most common pathogens are Streptococcus, Pneumococcus and Haemophilus influenzae. Some inflammations may start as viral, but develop into bacterial superinfection, i.e., subsequent colonization of the bacteria in 0.5-2% of cases. Viral sinusitis lasts for 7-10 days, whereas bacterial may take longer. The aim: The aim of this study was to compare three therapeutic protocols for the treatment of acute bacterial rhinosinusitis. Materials and Methods: A prospective clinical study was conducted at the Ear, Nose and Throat Clinic, Clinical Center Nis from October 2019 to January 2020, and it involved patients with acute bacterial rhinosinusitis in whom we compared the efficiency and safety of levofloxacin administration for five and 10 days with the efficiency of amoxicillin clavulanate treatment. The study included 62 patients with documented clinical and radiological symptoms. Results: Confirmation of bacterial etiology is not routinely performed in clinical practice since it requires antral puncture or endoscopic examination of the middle nasal meatus. Consequently, the choice of antibiotic therapy is empiric. In our study, we used levofloxacin for five (500 mg once a day) and 10 days (500 mg once a day) and amoxicillin-clavulanatefor 10 days (500 mg-125 mg three times a day), and the results showed no statistically significant difference in regard to the choice of antibiotics and the duration of therapy. Conclusion: The findings of this study suggest that a short course of antibiotic treatment has similar efficiency compared to a longer course of treatment of patients with uncomplicated acute bacterial sinusitis when treatment is indicated.