Sinusitis Newsletter

Publication date: 2004-02-27

Appropriate Antibiotic Therapy for Acute Bacterial Rhinosinusitis

This report was reviewed for medical and scientific accuracy by Catherine A. Monteleone, MD, Associate Professor of Medicine, Division of Allergy, Immunology and Infectious Diseases, University of Medicine & Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey

Expert Commentary

Michael S. Benninger, MD, Chair, Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan; Steering Committee of the Sinus and Allergy Health Partnership.

Appropriate antibiotic utilization is a common goal of clinicians everywhere, and is dependent on accurate diagnosis and thoughtful selection of antimicrobial therapy. Diagnostic guidelines developed by the Rhinosinusitis Task Force of the American Academy of Otolaryngology-Head and Neck Surgery are a useful clinical tool that can aid the differentiation of nonbacterial and bacterial rhinosinusitis and acute and chronic forms of the disease.¹ These guidelines identify major and minor factors associated with the disease and direct clinicians to consider symptom duration when evaluating patients with symptoms suggestive of the disease.

Treatment guidelines for bacterial rhinosinusitis continue to evolve as bacterial resistance patterns change and new antimicrobial therapies become available. The recently updated Sinus and Allergy Health Partnership (SAHP) guidelines for the treatment of acute bacterial rhinosinusitis provide clinicians with a simple algorithm that takes into consideration illness severity and recent history of antibiotic use to aid therapeutic decision making.² An improved mathematical model (the Poole Therapeutic Outcome Model) was used to predict efficacy of available antimicrobials and develop recommendations. This model considered multiple disease (pathogens and susceptibilities) and drug (pharmacokinetic and pharmacodynamic properties) factors that can influence outcomes. However, the model does not account for all factors that can influence choice of therapy. Other factors that clinicians must consider when choosing appropriate antibiotic therapy include those that influence compliance (eg, formulation, dosing frequency, taste, side effects, cost, and formulary availability). It is hoped that the availability of comprehensive guidelines such as these will improve antibiotic utilization and curb the further development of antibiotic resistance.

Introduction

In the age of increasing bacterial resistance, the importance of appro-priate antibiotic utilization is at the forefront of clinicians' minds. Streptococcus pneumoniae (S.pneumoniae), the most common cause of acute bacterial rhinosinusitis in adults and children, is increasingly resistant to commonly prescribed antibiotics, including penicillin, trimethoprim/sulfamethoxazole and doxycycline.² This increasing resistance is likely a result of a variety of factors, including the inappropriate use of antibiotics and noncompliance with prescribed antibiotic therapy.

The SAHP, a group of expert otolaryngologists representing the American Academy of Otolaryngic Allergy, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Rhinologic Society, recently updated comprehensive antibiotic treatment guidelines for acute bacterial rhinosinusitis.² These guidelines, published in the January 2004 issue of Otolaryngology-Head and Neck Surgery, highlight important patient, disease, and drug characteristics that clinicians should evaluate when prescribing antibiotics for the treatment of acute bacterial rhinosinusitis. Michael S. Benninger, MD, Chair, Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan presented highlights from these guidelines at the recent American Rhinologic Society Scientific Meeting held in September 2003 in Orlando, Florida.³ In his presentation, Dr. Benninger emphasized the importance of synthesizing patient and drug characteristics in the decision-making tr