Published Online August 28, 2013
Rhinosinusitis (sinus infections) are among the most common conditions encountered in medicine, and previous studies show antibiotics are prescribed extensively to treat rhinosinusitis. However, according to major consensus guidelines, antibiotics are not recommended for most patients with typical cases of acute sinus infections lasting less than 4 weeks, and the role of antibiotics for chronic sinus infections lasting more than 3 months is controversial.
In a Letter to the Editor in The Journal of Allergy & Clinical Immunology (JACI), Shintani-Smith et al. sought to describe the overall national burden of antibiotic burden for adult sinus infections. Study data were taken from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2006-2010, from the U.S. Department of Health and Human Services. Sample data included antibiotic prescriptions associated with outpatient visits made by adults diagnosed with acute or chronic rhinosinusitis.
Over the five year study period, sinus infections (acute and chronic combined) accounted for 11% of all primary diagnoses for ambulatory care visits with antibiotic prescriptions, more than any other diagnosis or commonly grouped diagnoses. Over the five year study period, there were 21.4 million estimated visits associated with a primary diagnosis of acute sinus infection, and 47.9 estimated visits associated with a primary diagnosis of chronic sinus infection. Despite established clinical practice guidelines recommending against the use of antibiotics for typical acute sinus infections, antibiotics were prescribed in 86% of acute rhinosinusitis and 69% of chronic rhinosinusitis visits.
The data demonstrate that sinus infections diagnoses are responsible for more outpatient antibiotic prescriptions than any other diagnosis, identifying rhinosinusitis as a major target in national efforts to reduce unnecessary medical intervention. Excessive antibiotic use is associated with consequences including allergic reactions, adverse effects, unnecessary costs, and increasing bacterial resistance. The authors conclude that current rhinosinusitis treatment recommendations should be promoted across specialties, and efforts to educate policymakers and the general public on the indications, benefits, and risks of antibiotics should be increased.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.