December 28, 2010

Doctors Using More Amoxicillin For Sinus Infections

According to a report published Tuesday in Pediatrics, U.S. doctors are using more of the antibiotic amoxicillin in children with acute sinus inflammation.

The authors say that the bad news is that inappropriate prescribing of other, more powerful antibiotics remains "common and unnecessary" in kids with sinus troubles.

Acute sinusitis accounts for over 3 million doctor visits annually and 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 efforts have been successful in encouraging the use of amoxicillin, instead of other 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 starts with a cold, which then leads to inflammation in the lining of the sinuses.  Colds cannot 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.

A "pneumococcal" vaccine against otitis media was introduced in 2000, which was followed by a substantial decrease in the number of cases.  The AAP recommended that amoxicillin be the "first-line therapy" for these ear infections in 2004.  The vaccine led to increase use of amoxicillin for ear infections.

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

Dr. Hersh, from University of Utah in Salt Lake City, along with colleagues at University of California, San Francisco addressed this question in their research. 

They reported that unlike office visits for otitis media, visits for sinusitis did not fall after the vaccine was introduced.

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 believe that over 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 told Reuters Health, "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."

The researchers found that 82 percent left with a prescription for any antibiotic.

However, the researchers said that proportion who received amoxicillin rose during the study period.

What is concerning, however, is that prescriptions for the "broader-spectrum" antibiotics, which attack a wider range of bacteria species, remained common at 18 percent overall.

This does not jive with AAP recommendations, which suggest reserving broader-spectrum antibiotics for certain cases, like people with very severe cases or those who have failed previous antibiotic therapy. 

The study team said that there is "mixed" evidence for the effectiveness of antibiotics for acute sinusitis in children. 

"Because of the continued tendency of physicians to prescribe antibiotics for treatment of acute sinusitis, this condition remains an important target for campaigns prompting judicious antibiotic use," they conclude.

"We need to continue to support efforts to promote judicious use of antibiotics," Hersh said. "Treatment guidelines from the AAP and campaigns such as the CDCs 'Get Smart - Know When Antibiotics Work' are very important in educating physicians and the public to ensure that antibiotics are used wisely," he added.


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