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Inappropriate Drugs Still Given For Sinus Woes

Inappropriate Drugs Still Given For Sinus Woes

A push to get US doctors to use the antibiotic amoxicillin in children with acute sinus inflammation appears to be paying off, a report published today in Pediatrics indicates.

That’s the good news. The bad news is that inappropriate prescribing of other, more powerful antibiotics remains “common and unnecessary” in kids with sinus woes, the authors say.

Acute sinusitis is very common, accounting for more than 3 million doctor visits annually. Antibiotics are frequently prescribed for this condition. Beginning in 2001, the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) emphasized amoxicillin as the preferred antibiotic for most children with sinusitis.

The new report finds that these efforts have been successful in encouraging use of amoxicillin, instead of other more “broad-spectrum” antibiotics.

“This is important,” Dr. Adam L. Hersh, an author on the report, told Reuters Health, “because amoxicillin is effective while at the same time, inexpensive and narrow-spectrum. Using broad spectrum antibiotics when narrow-spectrum antibiotics are appropriate may promote drug resistance and increases costs,” Hersh explained.

Acute sinusitis often begins when a cold, which is caused by a virus, leads to inflammation in the lining of the sinuses. Colds can’t be treated with antibiotics – but sometimes the inflammation leads to a bacterial infection. The bacteria Streptococcus pneumonia is a common cause of acute sinusitis and also of ear infections – what doctors call “otitis media.” The two are considered similar diseases.

In 2000, a “pneumococcal” vaccine against otitis media was introduced, which was followed by a substantial decrease in the number of cases. And in 2004, the AAP recommended that amoxicillin be the “first-line therapy” for these ear infections (meaning that patients with otitis media should take amoxicillin before trying any other antibiotic). The vaccine, and the 2004 recommendation, led to increased use of amoxicillin for ear infections.

Back in 2001, the AAP had also recommended that amoxicillin be the first-line therapy for acute sinusitis. But had similar trends occurred in children with acute sinusitis following introduction of the vaccine and the advice to use amoxicillin first?

Dr. Hersh, from University of Utah in Salt Lake City, and colleagues at University of California, San Francisco addressed this question in their research. They examined time trends in doctor visits and antibiotic prescribing patterns between 1998 and 2007 for a nationally representative sample of 538 children with symptoms of acute sinusitis.

Unlike office visits for otitis media, visits for sinusitis did not fall after the vaccine was introduced, they report.

In the 10 years spanning 1998 to 2007, trips to the doctor for acute sinusitis held steady; they ranged from 11 to 14 visits for every 1,000 children.

The researchers estimate that more than 8.9 million children saw a health care provider for acute sinusitis during the 10-year study period. This reflects an average of 895,000 visits each year.

“We were somewhat surprised,” Hersh admitted, “that the office visit rate for acute sinusitis did not decline after the pneumococcal vaccine was introduced, as was seen for acute otitis media and pneumonia.”

“Streptococcus pneumonia, which is the bacteria targeted by this vaccine, is a frequent cause for all three of these conditions,” he explained. “That said, our study may not have had sufficient sample size to detect a change in the frequency of sinusitis visits, if one did indeed occur.”

In a subset of 389 children, the researchers found that 82% left with a prescription for any antibiotic; this figure also held steady throughout the study period.

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