A recent study adds to the growing body of evidence showing that antibiotics are overused in the United States—this time for rhinosinusitis, which affects about 20% of the US population. The prospective, four-year study found that US physicians prescribed antibiotics for nearly 83% of acute sinus infections—even though acute sinus infections are most likely of viral origin rather than bacterial causes, and antibiotics are ineffective against viruses.
“Patients tend to feel better on antibiotics and many times antibiotics are the only drugs we have to offer. They often pressure doctors to prescribe antibiotics, probably as a result of direct-to-consumer ads. If their doctor doesn’t give them a prescription, they may consult another one,” explained Donald Leopold, MD, Professor and Chairman of the Department of Otolaryngology–Head and Neck Surgery at University of Nebraska Medical Center in Omaha, and senior author of the study. “It is astonishing that one in five antibiotics are prescribed for adults with rhinosinusitis,” he added.
Rhinosinusitis is one of the most expensive disorders in the United States, he continued, and accounts for 9% of prescriptions for antibiotics in children and 21% in adults. Rhinosinusitis also compromises quality of life, and treatment is often inconsistent among providers. This may be partly because it can be difficult to determine whether the infection is bacterial or viral in origin and because there is a lack of consensus on treatment algorithms.
Dr. Leopold said that watchful waiting, saline irrigation, and use of a decongestant or appropriate antimicrobial agent are the preferred treatments.
Two Large Surveys
The study was based on two large surveys: the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey collected by the National Center for Health Statistics. Only visits that resulted in a primary diagnosis of chronic (>12 weeks duration) or acute (<4 weeks duration) rhinosinusitis were included in the analysis. The authors estimated that from 1999 through 2002, more than 14 million visits per year were for chronic rhinosinusitis and more than 3 million were for acute rhinosinusitis, representing 1.39% and 0.30%, respectively, of all visits for ambulatory care.
Antibiotics were the most frequently recommended medications for both chronic and acute rhinosinusitis, followed by antihistamines, nasal decongestants, corticosteroids, and antitussive, expectorant, and mucolytic agents, respectively. Penicillins (i.e., amoxicillin or amoxicillin-clavulanate potassium) were the most frequently used antibiotic medications.
Reasons for Overuse/Overprescribing
In addition to pressure from patients for a prescription, Dr. Leopold said that doctors might be prescribing antibiotics “out of frustration” because there are no effective prescription drugs for chronic rhinosinusitis that have acceptable side effects. Also, he noted that the symptoms of acute and chronic rhinosinusitis are identical and include mucus, pressure, and impaired sense of smell. “Physicians are never quite sure if a patient with chronic rhinosinusitis doesn’t also have acute infection,” he noted.