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Antibiotics appear to be overprescribed for sinus infections

March 20, 2007

Antibiotics are prescribed for approximately 82 percent of acute sinus infections and nearly 70 percent of chronic sinus infections, despite the fact that viruses are by far the most frequent cause of this condition, according to a report in the March issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals.

Rhinosinusitis, an inflammation of the sinus cavities (adjacent to the nasal passages) and commonly referred to as a sinus infection, is a common and expensive medical condition in the United States, according to background information in the article. In 2002, rhinosinusitis accounted for 21 percent of all antibiotic prescriptions for adults and 9 percent of those for children. The infection is considered acute when symptoms last up to four weeks, and chronic when symptoms persist for 12 weeks or longer. Acute rhinosinusitis is usually thought to be caused by infectious agents, while allergies, facial anatomy and hormonal changes may contribute to chronic cases.

Hadley J. Sharp, B.S., and colleagues at the University of Nebraska Medical Center, Omaha, used data from two national surveys to assess the medications prescribed for sinus infections at physicians' offices and hospital outpatient and emergency departments between 1999 and 2002. The surveys were conducted by the National Center for Health Statistics and designed to be representative of the U.S. population.

Based on the data collected in the surveys, an estimated 14,277,026 visits to these health care facilities nationally per year were due to chronic rhinosinusitis and 3,116,142 were because of acute rhinosinusitis. The chronic visits represented 1.39 percent of total ambulatory care visits (in which the patient receives outpatient care), while acute cases represented .30 percent. "The most frequently recommended medications for treatment of both acute and chronic rhinosinusitis are antibiotic agents, followed by antihistamines; nasal decongestants; corticosteroids; and antitussive, expectorant and mucolytic agents, respectively," the authors write. At least one antibiotic was prescribed at 82.74 percent of visits for acute rhinosinusitis and 69.95 percent of those for chronic sinusitis.

"Prescription antibiotic drugs are being used far more than bacterial causes studies would indicate," the authors write. "Nasal and inhaled corticosteroids are prescribed more frequently to treat acute rhinosinusitis than published studies imply is necessary. Despite current theories of causes of chronic rhinosinusitis, the use of corticosteroids remains low in this setting. An area where our findings fit nicely with current information is use of antihistamines, which roughly matched the prevalence of their major indication, allergic rhinosinusitis."

It is possible that physicians may have been treating secondary infections with antibiotics in some the cases, the authors note. In addition, physicians may believe that antibiotics are effective because patients improved while taking them, while in fact the symptoms may have cleared up without treatment. "While keeping the goals of treatment in mind, there are concerns about the overuse of antibiotics and the resultant problems, including drug resistance and increasingly virulent bacteria," they write. "When two-thirds of patients with sinus symptoms expect or receive an antibiotic and as many as one-fifth of antibiotic prescriptions for adults are written for a drug to treat rhinosinusitis, these disorders hold special pertinence on the topic."

JAMA and Archives Journals