March 21, 2012 — New Infectious Diseases Society of America (IDSA) guidelines state that most cases of acute rhinosinusitis are caused by viruses and should not be treated with antibiotics.
According to a written release accompanying the guidelines, up to 98% of cases are caused by viruses, and therefore would not be responsive to antibiotics.
The guidelines, authored by an 11-member panel chaired by Anthony W. Chow, MD, professor emeritus of infectious diseases at the University of British Columbia, Vancouver, Canada, included contributions from experts from the US Centers for Disease Control and Prevention, the American College of Physicians, and the Society of Academic Medicine.
"There is no simple test that will easily and quickly determine whether a sinus infection is viral or bacterial, so many physicians prescribe antibiotics 'just in case,' " noted Dr. Chow in a news release. However, the use of antibiotics with viral infections may increase antibiotic resistance, costs, and the risk for adverse effects, he cautioned.
In a major shift from older guidelines developed by other organizations, the new IDSA guidelines also recommend treating bacterial sinus infections with amoxicillin-clavulanate vs amoxicillin, the current standard of care. The addition of clavulanate helps to overcome antibiotic resistance by inhibiting an enzyme that breaks the antibiotic down.
Dr. Chow notes that this recommendation was made because of increases in antibiotic resistance, as well as the widespread use of pneumococcal vaccines, which have changed the pattern of bacteria that cause sinus infections.
The guidelines also recommend against using other commonly used antibiotics, including azithromycin, clarithromycin, and trimethoprim-sulfamethoxazole, because of increasing drug resistance.
Other IDSA recommendations include shorter treatment times with antibiotics in adult patients; avoidance of decongestants and antihistamines, which may worsen symptoms; and use of irrigation with sterile solution.
The IDSA guidelines use the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system, which is designed to more clearly assess the quality of evidence and strength of recommendations.
"The guidelines are transparent, clearly stating the level of evidence for each recommendation and pointing out where we need more research," Thomas M. File Jr, MD, coauthor of the guidelines and chair of the Infectious Disease Section at Northeast Ohio Medical University, Rootstown, Ohio, noted in the news release.
Independent commentator Bradley F. Marple, MD, professor and vice chairman of the Department of Otolaryngology–Head and Neck Surgery at the University of Texas Southwestern Medical Center at Dallas, noted that these guidelines deviate significantly from the majority of existing evidence-based guidelines in their recommendations for empiric therapy for acute bacterial rhinosinusitis.
"While most national guidelines recommend the use of amoxicillin, the authors suggest a theoretic advantage for using amoxicillin-clavulanate as a first-line choice," Dr. Marple told Medscape Medical News.
"However, these concerns may not be supported by high-level clinical outcomes studies, which fail to demonstrate a clinical advantage of amoxicillin-clavulanate over amoxicillin."
According to Dr. Marple, in most guidelines, the authors rely on available high-level clinical outcome data, whereas in this case, IDSA has chosen to focus on microbiological data. "Empiric antibiotic recommendations in these guidelines are based upon 2 observations: the increasing prevalence of Haemophilus influenzae, and the increasing prevalence of beta-lactamase-producing respiratory pathogens in acute bacterial rhinosinusitis, many obtained from cultures of otitis media, which may not accurately reflect prevalence among rhinosinusitis cases overall."
According to a written release accompanying the guidelines, up to 98% of cases are caused by viruses, and therefore would not be responsive to antibiotics.
The guidelines, authored by an 11-member panel chaired by Anthony W. Chow, MD, professor emeritus of infectious diseases at the University of British Columbia, Vancouver, Canada, included contributions from experts from the US Centers for Disease Control and Prevention, the American College of Physicians, and the Society of Academic Medicine.
"There is no simple test that will easily and quickly determine whether a sinus infection is viral or bacterial, so many physicians prescribe antibiotics 'just in case,' " noted Dr. Chow in a news release. However, the use of antibiotics with viral infections may increase antibiotic resistance, costs, and the risk for adverse effects, he cautioned.
In a major shift from older guidelines developed by other organizations, the new IDSA guidelines also recommend treating bacterial sinus infections with amoxicillin-clavulanate vs amoxicillin, the current standard of care. The addition of clavulanate helps to overcome antibiotic resistance by inhibiting an enzyme that breaks the antibiotic down.
Dr. Chow notes that this recommendation was made because of increases in antibiotic resistance, as well as the widespread use of pneumococcal vaccines, which have changed the pattern of bacteria that cause sinus infections.
The guidelines also recommend against using other commonly used antibiotics, including azithromycin, clarithromycin, and trimethoprim-sulfamethoxazole, because of increasing drug resistance.
Other IDSA recommendations include shorter treatment times with antibiotics in adult patients; avoidance of decongestants and antihistamines, which may worsen symptoms; and use of irrigation with sterile solution.
The IDSA guidelines use the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system, which is designed to more clearly assess the quality of evidence and strength of recommendations.
"The guidelines are transparent, clearly stating the level of evidence for each recommendation and pointing out where we need more research," Thomas M. File Jr, MD, coauthor of the guidelines and chair of the Infectious Disease Section at Northeast Ohio Medical University, Rootstown, Ohio, noted in the news release.
Independent commentator Bradley F. Marple, MD, professor and vice chairman of the Department of Otolaryngology–Head and Neck Surgery at the University of Texas Southwestern Medical Center at Dallas, noted that these guidelines deviate significantly from the majority of existing evidence-based guidelines in their recommendations for empiric therapy for acute bacterial rhinosinusitis.
"While most national guidelines recommend the use of amoxicillin, the authors suggest a theoretic advantage for using amoxicillin-clavulanate as a first-line choice," Dr. Marple told Medscape Medical News.
"However, these concerns may not be supported by high-level clinical outcomes studies, which fail to demonstrate a clinical advantage of amoxicillin-clavulanate over amoxicillin."
According to Dr. Marple, in most guidelines, the authors rely on available high-level clinical outcome data, whereas in this case, IDSA has chosen to focus on microbiological data. "Empiric antibiotic recommendations in these guidelines are based upon 2 observations: the increasing prevalence of Haemophilus influenzae, and the increasing prevalence of beta-lactamase-producing respiratory pathogens in acute bacterial rhinosinusitis, many obtained from cultures of otitis media, which may not accurately reflect prevalence among rhinosinusitis cases overall."
Comments
Post a Comment