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Press Release Date: March 23, 1999
In treating uncomplicated acute bacterial sinusitis, inexpensive antibiotics, such as amoxicillin and folate inhibitors, are just as effective as newer and more expensive antibiotics, such as third generation cephalosporins. However, for many patients with acute sinusitis, symptoms will resolve without any antibiotics. These are the major findings of a study by the New England Medical Center Evidence-based Practice Center (EPC), under contract with the Agency for Health Care Policy and Research (AHCPR).
Acute sinusitis is one of the most common primary care problems in the United States. Millions of cases occur each year, affecting all age groups and all segments of the general population. Although not all people who contract the condition seek treatment from a physician, most still incur costs in work time lost or over-the-counter medications. In 1992, Americans spent $200 million on prescription cold medications and more than $2 billion for over-the counter medications.
Even though sinusitis is so common, its management is challenging. In most cases, the condition involves inflammation of both the sinuses (sinusitis) and nasal passages (rhinitis), but the causes vary. If the sinusitis is not caused by bacteria, treatment with antibiotics will have limited or no effect, and may have adverse side effects. However, because patients with bacterial sinusitis may develop a more serious sinus infection, it is important to properly diagnose and treat these patients. The Center's report focuses on the diagnosis and treatment of uncomplicated, community-acquired, acute bacterial sinusitis in children and adults.
"We are hopeful that the findings in this report will provide additional information that can assist health professionals with the diagnosis, treatment, and management of patients with this common condition that frequently is difficult to address," said Joseph Lau, M.D., Director, New England Medical Center EPC. Dr. Lau noted that the research found that using x-rays or other diagnostic procedures is not a cost-effective initial strategy for uncomplicated patients. He suggested that more research is needed to determine the best ways to screen patients for infections.
In addition to the findings above, the study concluded that:
- More patients were cured, and cured earlier, when treated with antibiotics rather than placebo; however, about two-thirds of patients receiving placebos recovered without antibiotics.
- More research is needed to identify simple, inexpensive, diagnostic methods to help distinguish patients requiring treatment with antibiotics from those not requiring antibiotics or further evaluation.
- Children need to be the specific focus of clinical research to determine the proper methods to diagnose and treat their sinusitis.
- Future studies should examine the connection between treatment and relapse rates or the development of recurrent sinusitis. Such results will help clarify the relationship between treatment and the amount of time it takes for symptoms to resolve. Studies also should address the optimal length of antibiotic treatment, the role of patient preferences in clinical decisionmaking, and the issue of emerging antibiotic resistance.
"Most of us have had sinusitis and know how bothersome it can be," said John M. Eisenberg, M.D., AHCPR's
Administrator. "This evidence report demonstrates the importance of building the evidence base for conditions seen in medical offices every day. Science isn't just for rare or life-threatening diseases. Good science, applied well, also can guide the care of our daily ailments and afflictions. The report's findings offer information that will help improve the quality of care for patients with sinusitis and potentially reduce the cost of treatment."
The conclusions about the diagnosis and treatment of acute bacterial sinusitis were based on 48 analyzable studies published within the last 30 years, and involving approximately 5,036 patients, including adults and children.
The evidence report was developed by the New England Medical Center EPC, in partnership with the American Academy of Otolaryngology-Head and Neck Surgery (AAOHN); American Academy of Pediatrics (AAP); American College of Physicians (ACP); and American Academy of Family Physicians. The AAOHN, AAP and ACP each have plans to develop or update clinical guidelines on acute sinusitis.
This evidence report is part of a series of evidence reports and technology assessments sponsored by AHCPR to provide public- and private-sector organizations with comprehensive, science-based information on common, costly medical conditions and health care technologies. The New England Medical Center is one of 12 AHCPR Evidence-based Practice Centers in the United States and Canada under contract to review all the relevant literature on designated topics and develop evidence reports or technology assessments.
A four-page summary of Evidence Report Number 9, Diagnosis and Treatment of Acute Bacterial Rhinosinusitis (AHCPR 99-E015), is available from AHCPR's Web site at: http://www.ahrq.gov/clinic/epcsums/sinussum.htm. Print copies are available from AHCPR Publications Clearinghouse by writing to P.O. Box 8547, Silver Spring, MD, 20907, or calling 800-358-9295 within the U.S., or (703) 437-2078 from outside the United States. Final copies of the full report will be available in mid-1999 from both the Clearinghouse and the National Library of Medicine's HSTAT full text retrieval system.
For additional information, please contact AHCPR Public Affairs: Karen Carp, (301) 427-1858 (KCarp@ahrq.gov); Karen Migdail, (301) 427-1855 (KMigdail@ahrq.gov). For further details about the study or to arrange an interview with EPC Director Joseph Lau, M.D., please call Joan Fallon, New England Medical Center Public Affairs Office at (617) 636-0200.